Dupilumab for bullous pemphigoid with intractable pruritus

Seidman, Jason S.; Eichenfield, Dawn Z; Orme, Charisse M.

doi:10.5070/d32511046147

Cited by 37 publications

(24 citation statements)

References 29 publications

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“…Dupilumab is a human monoclonal antibody directed to IL-4Ra, which modulates type 2 inflammation by inhibiting IL-4 and IL-13 signaling (31). Yet, only a few reports have demonstrated that refractory BP can be potentially treated with dupilumab (18)(19)(20)(21). Our study is a retrospective study to evaluate the efficacy and safety of dupilumab in combination with methylprednisolone and azathioprine in patients with moderateto-severe BP compared with treatment with methylprednisolone and azathioprine alone.…”

Section: Discussionmentioning

confidence: 99%

“…We think that this is because the systemic application of glucocorticoids alone is sufficient to reduce the level of peripheral blood eosinophils within a few hours ( 33 ). The efficacy of dupilumab in relieving pruritus may emphasize the type 2 immunity, which contributes to pruritus in AD and BP ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, biologic agents such as omalizumab (10)(11)(12)(13)(14) and rituximab (15)(16)(17) are widely used for refractory BP cases. Yet, there are very few reports suggesting the potential use of dupilumab in patients with BP (18)(19)(20)(21). Dupilumab is a fully human IgG4 monoclonal antibody directed against the IL-4 receptor alpha (IL-4Ra) subunit that inhibits the signaling of IL-4 and IL-13, two type 2 cytokines (22).…”

Section: Introductionmentioning

confidence: 99%

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

Zhang¹,

Xu²,

Chen³

et al. 2021

Front. Immunol.

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BackgroundBullous pemphigoid (BP) is an autoimmune blistering disorder that predominantly affects the elderly. As the main treatment for BP, systemic corticosteroids are often limited by their side effects. Safer treatment modalities are therefore needed. Dupilumab is a biologic agent used to treat BP in recent years.MethodsMedical records of patients with moderate-to-severe BP were retrospectively reviewed. Twenty-four patients were included (follow-up period: 32 weeks), eight of whom received dupilumab in combination with methylprednisolone and azathioprine (dupilumab group) while the other 16 patients received methylprednisolone and azathioprine (conventional group). Response to dupilumab was evaluated by comparison of several parameters (time to stop new blister formation, time to reduce the systemic glucocorticoids to minimal dose, and total amount of methylprednisolone).ResultsThe median age of patients in the dupilumab and conventional groups were 64.50 years (range: 22–90 years) and 64.50 years (range: 17–86 years), respectively. The median duration of disease before admission in the dupilumab group was 2 months (range: 1–240 months) and 2.5 months (range: 1–60 months) in the conventional group. The median time to stop new blister formation was 8 days (range: 1–13 days) and 12 days (range: 5–21 days) in patients of the dupilumab and conventional groups, respectively (p = 0.028 by Kaplan-Meier analysis). In addition, the median time to reduce the systemic glucocorticoids to minimal dose (methylprednisolone 0.08 mg/kg/day) was 121.5 and 148.5 days for the dupilumab and conventional therapy groups, respectively (p = 0.0053 by Kaplan-Meier analysis). The median total amount of methylprednisolone (at the time of reaching the minimal dose) used in the dupilumab group was 1,898 mg (range: 1,624–2,932 mg) while the cumulative dose of conventional group was 2,344 mg (range: 1,708–4,744 mg) (p = 0.036 by Mann-Whitney U test). The median total amount of azathioprine (at the time of reaching the minimal dose) used in dupilumab group was 8,300 mg (range: 7,100–10,400 mg) while the total dose of conventional group was 10,300 mg (range: 8,900–14,400 mg) (p = 0.0048 by Mann-Whitney U test). No adverse event related to dupilumab was recorded.ConclusionsDupilumab in addition to methylprednisolone and azathioprine seems superior to methylprednisolone/azathioprine alone in controlling disease progression and accelerating the tapering of glucocorticoids.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Zhang¹,

Xu²,

Chen³

et al. 2021

Front. Immunol.

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“…Therefore, Dupilumab could specifically block the pathogenic effects of these cytokines in BP (105). Recently, Dupilumab has been successfully used in refractory BP, especially for the relief of intractable itching (106).…”

Section: Biologics Targeting Th2 Axismentioning

confidence: 99%

Emerging Biomarkers and Therapeutic Strategies for Refractory Bullous Pemphigoid

2021

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Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder in the elderly. Systemic and topical use of glucocorticoids and immunosuppressants has been shown to be effective in most patients. However, refractory BP patients are challenged to clinicians with severe clinical symptoms, resistance to treatment, and high relapse rate. How to predict and assess the refractory and severity of bullous pemphigoid is the key issue in clinical practice, and the urgent need for precision medicine in refractory patients is driving the search for biomarkers and biologics. Recently, some biomarkers, such as the level of specific autoantibodies and released cytokines, have been proposed as the potential parameters to reflect the disease severity and predict the treatment response and relapse of refractory BP. Moreover, new biologics targeting pathogenic antibodies, complement, Th2 axis, eosinophils, and Th17 axis have shown potent efficacy on refractory BP. Here, we review the literature and give an overview of emerging biomarkers and therapeutic strategies for refractory bullous pemphigoid to improve the prognosis of the patient.

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“…Over the past five years, a variety of small case reports and series have described the efficacy of dupilumab in BP (15)(16)(17)(18)(19), in which a multicenter case series of 13 refractory BP patients was conducted in American, leading to satisfactory disease control in most cases (15). No dupilumab-related adverse events reported thus far.…”

Section: Introductionmentioning

confidence: 99%