Severe bullous pemphigoid following Covid‐19 vaccination resistant to rituximab and successfully treated with dupilumab

Baffa, Maria Efenesia; Maglie, Roberto; Montefusco, Francesca; Pipitò, Carlo; Senatore, Stefano; Antiga, Emiliano

doi:10.1111/jdv.18673

Cited by 15 publications

(17 citation statements)

References 6 publications

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“…6 According to a case series of 21 patients with BP induced by SARS-CoV-2 vaccination, 2 vaccine-associated BP patients seem to be similar to idiopathic BP with an overall benign course. Our patient, such as the case reported by Baffa et al, 1 had a severe clinical course and was refractory to corticosteroids. A randomized doubleblind trial proved that a single cycle of IVIG is a safe and effective therapy for patients with BP.…”

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Reply to: ‘Severe bullous pemphigoid following Covid‐19 vaccination resistant to rituximab and successfully treated with dupilumab’ by Baffa et al.

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et al. 2023

Acad Dermatol Venereol

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confidence: 59%

“…Dear Editor, We read with interest the article by Baffa et al, 1 who reported a case of severe bullous pemphigoid (BP) developed 10 days after the second dose of Pfizer/BioNtech BNT162b2 mRNA vaccine against Covid-19, resistant to rituximab and successfully treated with dupilumab.…”

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confidence: 99%

Reply to: ‘Severe bullous pemphigoid following Covid‐19 vaccination resistant to rituximab and successfully treated with dupilumab’ by Baffa et al.

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et al. 2023

Acad Dermatol Venereol

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“…Several case reports, case series, and a recent Italian multicenter study proposed a possible, so far unproven, causal relationship between COVID-19 vaccination and AIBD onset ( Supplementary Table 1 ) ( 41 – 91 ). To our knowledge 51 studies reporting new-onset AIBDs, with a total of 121 patients that developed BP (92 cases), anti-p200 pemphigoid (1 case), pemphigus (1 case), PV (15 cases), pemphigus foliaceus (PF) (7 cases), pemphigus vegetans (1 case), and LABD (4 cases) following SARS-CoV-2 vaccination ( Supplementary Table 1 ) were published.…”

Section: New-onset Of Aibds Associated With Covid-19 Vaccinesmentioning

confidence: 99%

Autoimmune bullous diseases during COVID-19 pandemic: 2022 update on rituximab and vaccine

et al. 2023

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Autoimmune bullous diseases (AIBDs) are a heterogeneous group of life-threatening disorders associated with subepidermal or intraepidermal blistering. Skin barrier alterations and prolonged immunosuppressive treatments increase the risk of infections in patients with AIBDs, who are considered fragile. COVID-19 pandemic had a heavy impact on these patients. Although advances have been made in terms of prevention and treatment of COVID-19, this topic remains significant as the pandemic and its waves could last several years and, so far, a relevant proportion of the population worldwide is not vaccinated. This review is a 2022 update that summarizes and discusses the pandemic’s burden on AIBD patients mainly considering relevant studies in terms of: (i) sample dimension; (ii) quality of control populations; (iii) possible standardization by age, gender and country. The findings show that: (i) the risk of COVID-19 infection and its severe course were comparable in AIBD patients and in the general population, except for rituximab-treated patients that presented a higher risk of infection and severe disease; (ii) the mortality rate in COVID-19-infected bullous pemphigoid patients was higher than in the general population, (iii) 121 cases of AIBD onset and 185 cases of relapse or exacerbation occurred after COVID-19 vaccination and a causal relationship has not been demonstrated so far. Altogether, acquired knowledge on COVID-19 pandemic could also be important in possible, albeit undesirable, future pandemic scenarios.

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“…In addition, 4 cases of checkpoint inhibitor-induced BP were treated efficiently with dupilumab, a favorable medication as strong immunosuppression needs to be avoided due to the underlying malignancy [ 121 , 122 , 123 , 124 ]. Two patients with BP presumably triggered by COVID-19 vaccinations were also treated efficiently with dupilumab [ 120 , 125 ]. Most noticeably, two retrospective cohort studies compared co-therapy of dupilumab with conventional therapy against conventional therapy alone (comprised of systemic high-dose steroids and immunosuppressants) and found shorter median time to disease control, more rapid decline of itch measured by NRS and disease activity (measured by the BP disease activity index, BPDAI), higher quality of life (measured by the dermatology life quality index, DLQI) as well as lower cumulative doses of steroids and immunosuppressants in a total of 28 patients [ 126 , 127 ].…”

Section: Resultsmentioning

confidence: 99%

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

et al. 2023

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Dupilumab was first approved for the treatment of atopic dermatitis (AD) and blocks the signaling of interleukin (IL)-4 and -13. Several other chronic skin conditions share mechanistic overlaps with AD in their pathophysiology, i.e., are linked to type 2 inflammation. Most recently, dupilumab was approved by the U.S. Food and Drug Administration for prurigo nodularis (PN). Given its relatively good safety profile, effective off-label use of dupilumab has been reported for a multitude of dermatologic diseases and several clinical trials for dermatologic skin conditions are currently ongoing. We conducted a systematic review of applications of dupilumab in dermatology other than AD and PN by searching the databases PubMed/Medline, Scopus, Web of Science and Cochrane Library as well as the clinical trial registry ClinicalTrials.gov. We found several reports for effective treatment of bullous autoimmune diseases, eczema, prurigo, alopecia areata, chronic spontaneous urticaria, Netherton syndrome and a variety of other chronic inflammatory skin diseases.

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Severe bullous pemphigoid following Covid‐19 vaccination resistant to rituximab and successfully treated with dupilumab

Cited by 15 publications

References 6 publications

Reply to: ‘Severe bullous pemphigoid following Covid‐19 vaccination resistant to rituximab and successfully treated with dupilumab’ by Baffa et al.

Reply to: ‘Severe bullous pemphigoid following Covid‐19 vaccination resistant to rituximab and successfully treated with dupilumab’ by Baffa et al.

Autoimmune bullous diseases during COVID-19 pandemic: 2022 update on rituximab and vaccine

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

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