Rapid itch reduction in bullous pemphigoid linked to dupilumab treatment

Key takeaways:

• Pruritus was reduced by 47.56% as early as day 1 and 95.6% at the final follow-up visit.
• Fast itch relief was correlated to a clinical response on day 14.

Rapid itch reduction was positively correlated with treatment response among patients taking dupilumab for bullous pemphigoid, according to a study.

“Bullous pemphigoid (BP) is the most common autoimmune blistering disease usually affecting elderly patients,” Jeivicaa Thevan, of the department of dermatology at the University Hospital Zurich, and colleagues wrote. “Most systemic treatment options are immunosuppressive, and their excessive usage is considered an important risk factor in causing a fatal outcome, implying the need for a more specific immunomodulatory therapy without general immunosuppressive features.”

To elucidate the clinical features, particularly the course of itch, of dupilumab-treated patients with BP, the authors conducted a retrospective study Of 12 patients (mean age, 76 years; 33% women) with BP that were treated with 600 mg of dupilumab subcutaneously followed by 300 mg every 2 weeks for an average of 4.5 months. Results showed that eight of the patients achieved a complete response to dupilumab treatment whereas the remaining four had partial responses.

Pruritus was reduced by 47.6% as early as day 1 and was further reduced by 73.3% on day 3, 71.2% on day 14, 85.1% on day 28, 89.1% on day 56 and 95.6% at the final follow-up visit (P < 0.0001 for all).

Results also showed that fast itch relief was correlated to a clinical response on day 14 (Spearman correlation coefficient, 0.7; P < .025), indicating that fast itch relief could predict treatment response.

All but one patient used dupilumab as a monotherapy through the end of the study without supplementing with systemic or topical treatments.

“Dupilumab adds to the existing treatment options in BP as a safe treatment without strong general immunosuppressive action,” the authors wrote. “This could change how BP is treated in the future, especially in patients with augmented risk of an increased mortality in the setting of advanced age and significant comorbidities.”