Dupilumab: A Novel Therapy for Bullous Pemphigoid

Dupilumab, a potentially novel therapy for bullous pemphigoid (BP), has shown encouraging results in a retrospective cohort study conducted by the National Autoimmune Bullous Diseases Cooperative Group of China. The study aimed to assess the efficacy and safety of dupilumab in patients with BP and identify factors affecting short-term and long-term outcomes. The findings were published in the Journal of the American Medical Association.

About Bullous Pemphigoid

Bullous pemphigoid is a rare autoimmune skin disorder that causes large blisters on the skin's surface. It is often characterized by intense itching and discomfort. Conventional treatments have been limited, prompting researchers to explore novel therapies like dupilumab.

The Study

The retrospective cohort study spanned from January 2021 to July 2022 and involved 146 adult patients with BP. The participants received 300 mg of dupilumab every two weeks following an initial dose of 600 mg. To be eligible, patients had to show clinical signs of BP with supporting immunological or pathological evidence. Patients with drug-induced BP, less than four weeks of follow-up, or those who had received dupilumab or any other biologics within the last six months were excluded.

Study Outcomes

The primary outcome of the study was the proportion of patients who achieved disease control within four weeks. Disease control was defined as the absence of new lesions and itching, along with the healing of existing lesions. The results were promising, with 87.0% of patients achieving disease control within four weeks, and it took a median time of 14 days to achieve this. Additionally, 35.6% of patients achieved complete remission during the observation period, while 8.9% experienced relapses.

Throughout the follow-up period, the researchers observed rapid and sustained improvements in clinical indicators and laboratory results, including:

• Bullous Pemphigoid Disease Area Index (BPDAI) scores
• Itching numerical rating scale (NRS) scores
• Serum anti-BP180 and anti-BP230 antibodies
• Total IgE levels
• Eosinophil count

Safety Profile

Dupilumab treatment demonstrated a favorable safety profile in the study. The most common adverse events reported were infections and eosinophilia. Notably, the researchers found that patients with anti-BP180 antibody levels of at least 50 relative units (RU)/mL were associated with better disease control within four weeks.

Reference

Zhao, L., Wang, Q., Liang, G., Zhou, Y., Yiu, N., Yang, B., Zhang, G., Li, W., Feng, S., Shang, P., Chen, X., Zhu, X., Zheng, J., Pan, M., & Wang, M. (2023). Evaluation of Dupilumab in Patients With Bullous Pemphigoid. In JAMA Dermatology. American Medical Association (AMA). https://doi.org/10.1001/jamadermatol.2023.2428