Commentary: Efficacy and Safety of Dupilumab in Moderate-to-Severe Bullous Pemphigoid

Wang, Si-Hang; Zuo, Ya‐Gang

doi:10.3389/fimmu.2021.800609

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Complex immune interactions associated with the Th2 axis, including the cytokines IL-4 and IL-13 and chemokines and eosinophils, are involved in the pathogenesis of BP. The IL-4 receptor alpha antagonist dupilumab inhibits B-cell proliferation, eosinophil chemotaxis, and Th2 chemokines expression by blocking IL-4 and IL-13 signaling and ultimately leads to BP remission ( 91 ).…”

Section: Discussionmentioning

confidence: 99%

Rituximab, Omalizumab, and Dupilumab Treatment Outcomes in Bullous Pemphigoid: A Systematic Review

Cao

Zhang

2022

Front. Immunol.

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BackgroundBullous pemphigoid (BP) is the most common autoimmune subepidermal bullous disease of the skin. First-line treatment of systemic corticosteroids may cause serious adverse events. Rituximab, omalizumab, and dupilumab should be explored as alternative treatment options to improve outcomes.ObjectiveTo systematically review the rituximab, omalizumab, and dupilumab treatment outcomes in bullous pemphigoid.MethodsA PubMed, Embase, Web of Science, and Cochrane library search were conducted on March 10, 2022. A total of 75 studies were included using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.ResultsUse of rituximab (n=122), omalizumab (n=53) and dupilumab (n=36) were reported in 211 patients with BP. Rituximab led to complete remission in 70.5% (n=86/122) and partial remission in 23.8% (n=29/122) of patients within 5.7 months, with a recurrence rate of 20.5% (n=25/122). 9.0% (n=11/122) of patients died and infection (6.6%, n=8/122) was the most common adverse event. Omalizumab led to complete remission in 67.9% (n=36/53) and partial remission in 20.8% (n=11/53) of patients within 6.6 months, with a recurrence rate of 5.7% (n=3/53). 1.9% (n=1/53) of patients died and thrombocytopenia (1.9%, n=1/53) was observed as the most common adverse event. Dupilumab led to complete remission in 66.7% (n=24/36) and partial remission in 19.4% (n=7/36) of patients within 4.5 months of treatment without any reported adverse events, with a recurrence rate of 5.6% (n=2/36).ConclusionsRituximab, omalizumab, and dupilumab have similar clinical benefits for BP patients. However, rituximab resulted in higher recurrence rates, adverse events, and mortality rates.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022316454.

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Section: Discussionmentioning

confidence: 99%

Rituximab, Omalizumab, and Dupilumab Treatment Outcomes in Bullous Pemphigoid: A Systematic Review

Cao

Zhang

2022

Front. Immunol.

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“…7 Dupilumab is not currently approved for the treatment of BP. However, due to the role of Th2-mediated inflammation in the pathogenesis of BP, research initiatives around the world [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] and within China [24][25][26][27] have used dupilumab to treat refractory or moderate to severe BP. We attempted to use dupilumab to treat 11 BP patients whose underlying diseases made conventional treatment ineffective or who had poor responses to conventional treatment, and we achieved positive results.…”

Section: Discussionmentioning

confidence: 99%

“… 7 Dupilumab is not currently approved for the treatment of BP. However, due to the role of Th2‐mediated inflammation in the pathogenesis of BP, research initiatives around the world 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 and within China 24 , 25 , 26 , 27 have used dupilumab to treat refractory or moderate to severe BP.…”

Section: Discussionmentioning

confidence: 99%

Concomitant use of dupilumab with glucocorticoid in bullous pemphigoid reduces disease severity: A preliminary study

Huang

Fu-qiong

et al. 2023

Immunity Inflam & Disease

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Objective To retrospectively analyze the efficacy and safety of dupilumab in the treatment of bullous pemphigoid. Methods From October 2020 to October 2022, the medical records of patients with bullous pemphigoid who were treated with dupilumab in our department were collected retrospectively to analyze the therapeutic effect and changes in laboratory indexes. Results The records of a total of 11 patients with bullous pemphigoid who were treated with dupilumab was reviewed. Within 2 weeks of the treatment, 10 (90.9%) of the 11 patients had complete or substantial control of the disease. The BPDAI scores of the patients decreased from baseline 113 (62, 181) to 37 (6, 130) at 2 weeks (p = .001) and 4 (0, 37) at 12 weeks after treatment (p < .001). In the 11 patients treated with dupilumab, the relief time of pruritus was 0–3 days (0.5, 7) days, and the pruritus was significantly alleviated after 2 weeks (t = 15.925, p < .001). The DLQI score decreased from (25.5 ± 2.5) before treatment, to (11.8 ± 4.4) at 2 weeks (t = 10.764, p < .001) and (2.1 ± 1.9) at 12 weeks (t = 30.038, p < .001). The patients had high eosinophil counts, high serum IgE levels, low serum total protein levels, and abnormal blood coagulation function. The aforementioned indicators gradually returned to normal after treatment. No adverse reactions occurred during the treatment. Conclusion Dupilumab can effectively control the condition of bullous pemphigoid, efficiently relieve pruritus symptoms, and is relatively safe.

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“…DUPI is an IL-4 receptor alpha antagonist, and its efficacy is related to the Th2 inflammatory axis involved in BP pathogenesis. DUPI directly inhibits the activity of IL-4 and IL-13; however, it also downregulates eosinophil chemotaxis and inhibits preactivated B-cell proliferation ( 16 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

Biological treatment for bullous pemphigoid

et al. 2023

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BackgroundBullous pemphigoid (BP) is the most common autoimmune subepidermal bullous disease. Topical or systemic corticosteroids are often used as the first-line treatment. However, long-term corticosteroid use may lead to significant side effects. Therefore, various adjuvant immunosuppressant therapies are used as steroid-sparing agents, with accumulating reports of biological treatments for severely recalcitrant BP.ObjectiveTo describe the clinical and immunological features of a series of patients with recalcitrant BP treated with immunobiological therapies. To assess the efficacy and safety of their therapies.MethodsPatients receiving biological treatment for BP from two centers were assessed. Here, we described the clinical, immunopathological, and immunofluorescence findings of adult patients with BP and analyzed the clinical response and adverse events associated with various biological therapies.ResultsWe identified nine eligible patients treated with rituximab (seven), omalizumab (three), or dupilumab (one). The mean age at diagnosis was 60.4 years, the average BP duration before biologic initiation was 1.9 years, and the average previous treatment failure was 2.11 therapies. The mean follow-up period from the first biological treatment to the last visit was 29.3 months. Satisfactory response, defined as clinical improvement, was achieved in 78% (7) of the patients, and total BP clearance was achieved in 55% (5) of the patients at the last follow-up visit. Additional rituximab courses improved the disease outcomes. No adverse events were reported.ConclusionsEfficient and safe novel therapies can be considered in recalcitrant steroid-dependent BP non-responsive to conventional immunosuppressant therapies.

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Commentary: Efficacy and Safety of Dupilumab in Moderate-to-Severe Bullous Pemphigoid

Cited by 5 publications

References 19 publications

Rituximab, Omalizumab, and Dupilumab Treatment Outcomes in Bullous Pemphigoid: A Systematic Review

Rituximab, Omalizumab, and Dupilumab Treatment Outcomes in Bullous Pemphigoid: A Systematic Review

Concomitant use of dupilumab with glucocorticoid in bullous pemphigoid reduces disease severity: A preliminary study

Biological treatment for bullous pemphigoid

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