Dupilumab should be considered as treatment option for bullous pemphigoid

Key takeaways:

• 50% of patients treated with dupilumab achieved complete remission of blistering lesions.
• Sixteen patients experienced complete remission of pruritus as well.

Clinicians should consider dupilumab as a therapeutic option for bullous pemphigoid due to its ability to clear blistering and pruritus safely, according to a study.

Bullous pemphigoid (BP) is a common autoimmune subepidermal blistering disease that can be controlled with topical corticosteroids when mild. However, more severe cases are difficult to treat.

“Systemic immunosuppression with oral corticosteroids remains the first-line treatment for widespread cases, often leading to detrimental side effects, although effective,” Austinn C. Miller, MD, a dermatology resident at Tallahassee Memorial Health, and colleagues wrote. “More recently, with the established importance of interleukin-4 and IL-13 cytokines in autoimmune blistering diseases, the IL-4Ra inhibitor, dupilumab, has risen as a plausible therapeutic option.”

In this case series, 30 adult patients received a 600 mg loading dose of dupilumab followed by a 300 mg maintenance dose with varying administration frequency based on patient need. As this was a case series, treatment periods ranged from 2 to 100 weeks and 73.3% received dupilumab biweekly.

Results showed that 50% of patients treated with dupilumab for BP achieved complete remission of blistering lesions. Eight other patients reported marked response in their blistering, whereas moderate and minimal responses were reported by four and three patients, respectively.

Sixteen patients experienced complete remission of pruritus while other experienced marked response (n = 9), moderate response (n = 2) and minimal response (n = 3).

Only one patient experienced an adverse event (injection site reaction). Also, one patient died of natural causes, one discontinued treatment due to inadequate response and two were lost to follow-up.

The remaining 27 patients requested to continue dupilumab treatment.

Additionally, nine patients were weaned off concomitant treatments and were maintained solely on dupilumab.

“This is beneficial as many traditional therapies used for BP carry toxic side effects and require more frequent monitoring,” the authors wrote. “Moreover, depending on patient responses, some maintenance dosing intervals were increased up to every 8 weeks, thus mitigating the risks and costs incurred with more frequent administration.”