World Workshop of Oral Medicine VII: A systematic review of immunobiologic therapy for oral manifestations of pemphigoid and pemphigus

Abstract

Objective To assess the evidence for treatment of oral involvement of pemphigus and pemphigoid with biologics. Study Design This systematic review used a comprehensive search strategy to identify literature describing oral involvement of pemphigus or pemphigoid treated with a biologic agent. The primary outcome measures were efficacy and safety of biologic therapy. Results Inclusion criteria were met by 154 studies including over 1200 patients. Treatment of pemphigus with a total of 11 unique biologic agents and 3 unique combinations of agents is reported. Five randomized controlled trials (RCT) were included in the final analysis that investigated infliximab, IVIg, rituximab, and autologous platelet‐rich plasma therapy for pemphigus vulgaris. Three non‐RCT studies reported on successful rituximab or IVIg therapy for mucous membrane pemphigoid. Studies demonstrated considerable heterogeneity in agent, methods, and quality. Conclusions Evidence clearly describing oral tissue response to biologic therapy is sparse. Two RCTs support use of rituximab, one supports use of IVIg, and one pilot study suggests intralesional injection of autologous platelet‐rich plasma aids healing of oral PV lesions. As oral lesions of pemphigus and pemphigoid can be refractory to systemic therapy, drug trials including biologic therapies should document details regarding response of the oral lesions to therapy.

Pênfigo vulgar em condição avançada na atenção básica: relato de caso

“…Embora nenhuma etiologia clara tenha sido estabelecida para essas doenças, a complexa patogênese da PV envolve a geração de autoanticorpos contra proteínas conjuntivas da pele e mucosa, incluindo caderinas desmossomais (Tavakolpour, 2017;Mays, et al, 2020). A desmogleína 3 é o principal antígeno, mas 50-60% dos pacientes também têm anticorpos antidesmogleína 1 (Cozzani et al, 2013;Kasperkiewics et al, 2017;Mays et al, 2020).…”

“…Embora nenhuma etiologia clara tenha sido estabelecida para essas doenças, a complexa patogênese da PV envolve a geração de autoanticorpos contra proteínas conjuntivas da pele e mucosa, incluindo caderinas desmossomais (Tavakolpour, 2017;Mays, et al, 2020). A desmogleína 3 é o principal antígeno, mas 50-60% dos pacientes também têm anticorpos antidesmogleína 1 (Cozzani et al, 2013;Kasperkiewics et al, 2017;Mays et al, 2020). O claro papel dos autoanticorpos na patogênese da PV sugere um importante papel terapêutico para agentes direcionados que bloqueiam a geração ou sobrevivência de componentes imunológicos autorreativos (Ellebrecht & Payne, 2017;Buonavoglia et al, 2019;Mays et al, 2020).…”

“…A desmogleína 3 é o principal antígeno, mas 50-60% dos pacientes também têm anticorpos antidesmogleína 1 (Cozzani et al, 2013;Kasperkiewics et al, 2017;Mays et al, 2020). O claro papel dos autoanticorpos na patogênese da PV sugere um importante papel terapêutico para agentes direcionados que bloqueiam a geração ou sobrevivência de componentes imunológicos autorreativos (Ellebrecht & Payne, 2017;Buonavoglia et al, 2019;Mays et al, 2020). Research, Society and Development, v. 10, n. 2, e0810212270, 2021 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i2.12270…”

“…Os primeiros sinais da doença, em mais de 50% dos casos, surgem na mucosa oral (Nascimento et al, 2020). Embora não haja predileção por área, as lesões podem estar localizadas na mucosa bucal, palato mole, lábio inferior, língua e, com menos frequência, na gengiva (Saccucci et al, 2018;Mays, et al, 2020). Essas lesões orais podem variar de úlceras bastante superficiais, a pequenas vesículas ou bolhas.…”

Effectiveness of Topical Application of Heterologous Platelet Rich Plasma (PRP) in Oral Mucous Membrane Pemphigoid. A Report of a Case

“…However, long term use of steroids is well known to expose the patient to the risk of moderate to severe side effects. [1] For this reason, the use of alternative therapies or corticosteroid sparing agents to control disease is highly attractive [1,2]. In the present paper we describe the management of a case of mucous membrane pemphigoid treated with topical application of heterologous PRP.…”