Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain.
Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.
J Dermatolog Treat. 2022 Nov;33(7):2886-2893. doi: 10.1080/09546634.2022.2089331. Epub 2022 Jun 20.
Several therapies for psoriasis have been described as triggers of biologic-induced bullous pemphigoid (BIBP). The real incidence of BIBP in psoriatic patients is still unknown. Hence, we compilated and analyzed current literature to identify the frequency and burden of this adverse event for psoriasis patients treated with biologics.
We systematically searched literature records involving psoriatic patients developing BIBP. Electronic searches were conducted in Pubmed, EMBASE and Scopus in April 2021. To assess the causal relationship between BP and the biologic drug, we applied the Naranjo adverse reaction probability scale and the Karch-Lasagna algorithm.
Our systematic review identified 586 records through the three electronic databases. We identified 15 case reports of BIBP. These cases implicated two cases induced by adalimumab, three by efalizumab, three by etanercept, six by ustekinumab, and one case by secukinumab. Mean period of latency until the BIBP developed was time 5.12 ± 3.44 weeks for TNF-α blockers, and 28.66 ± 26.27 weeks for ustekinumab ( = .09). Most of the cases were assessed as "probable" consistently in both the Naranjo scale and the Karch-Lasagna algorithm.
This work presents an accurate estimation on the frequency and burden of BIBP. Ustekinumab presents with the largest evidence of BIBP, especially in patients with previous failure to TNF-α agents. Distinct patterns in the cytokinic pathways and clinical course exist between the BP induced by TNF-α blockers and ustekinumab. A close monitoring of skin condition is highly advisable in patients receiving biologic therapies for psoriasis. Knowledge of BIBP is of great importance to determine the preventive measures and select optimal treatment options.What's already known about this topic?The widespread use of biologic drugs has led dermatologists to encounter increasing situations of biologic-induced BP (BIBP).A lack of data exists on the real incidence of BIBP in psoriatic patients.BIBP is an important adverse event to know when managing patients with psoriasis using biologics.What does this study add?This work presents an accurate estimation on the raised burden of BIBP.Ustekinumab presents with the largest evidence of BIBP, especially in patients with previous failure to TNF-α agents.Mean period of latency until the BIBP developed was time 5.12 ± 3.44 weeks for TNF-α blockers, and 28.66 ± 26.27 weeks for ustekinumab.Distinct patterns in the cytokine pathways and clinical course exist between the BP induced by TNF-α blockers and ustekinumab.A careful screening of previous history of bullous diseases and a baseline immunologic study in psoriatic patients should be advisable prior to commencing any biologic therapy.A close monitoring of skin condition is highly advisable in patients receiving biologic therapies for psoriasis.
已有多种疗法被描述为银屑病生物制剂诱导性大疱性类天疱疮（BIBP）的触发因素。在银屑病患者中，BIBP 的真实发病率仍不清楚。因此，我们对现有文献进行了汇编和分析，以确定接受生物制剂治疗的银屑病患者发生这种不良事件的频率和负担。
我们系统地检索了涉及发生 BIBP 的银屑病患者的文献记录。2021 年 4 月，在 Pubmed、EMBASE 和 Scopus 中进行了电子检索。为了评估 BP 与生物药物之间的因果关系，我们应用了 Naranjo 不良反应概率量表和 Karch-Lasagna 算法。
我们的系统综述通过三个电子数据库共确定了 586 条记录。我们确定了 15 例 BIBP 的病例报告。这些病例涉及两例阿达木单抗诱导、三例依那西普诱导、三例依那西普诱导、六例乌司奴单抗诱导和一例司库奇尤单抗诱导。TNF-α 阻滞剂诱导的 BIBP 的潜伏期平均为 5.12±3.44 周，乌司奴单抗诱导的 BIBP 的潜伏期平均为 28.66±26.27 周（=0.09）。Naranjo 量表和 Karch-Lasagna 算法均一致将大多数病例评估为“可能”。
本研究对 BIBP 的频率和负担进行了准确估计。乌司奴单抗在 BIBP 方面的证据最多，尤其是在 TNF-α 药物治疗失败的患者中。TNF-α 阻滞剂诱导的 BP 和乌司奴单抗诱导的 BP 在细胞因子途径和临床病程方面存在明显差异。在接受银屑病生物治疗的患者中，高度建议密切监测皮肤状况。了解 BIBP 对于确定预防措施和选择最佳治疗方案非常重要。
关于这个话题已经知道些什么？生物制剂的广泛应用使皮肤科医生越来越多地遇到生物制剂诱导性 BP（BIBP）的情况。关于银屑病患者中 BIBP 的真实发病率，目前数据不足。BIBP 是管理使用生物制剂治疗银屑病患者时需要了解的一个重要不良事件。
这项研究增加了哪些新内容？本研究对 BIBP 负担的增加进行了准确估计。乌司奴单抗在 BIBP 方面的证据最多，尤其是在 TNF-α 药物治疗失败的患者中。TNF-α 阻滞剂诱导的 BIBP 的潜伏期平均为 5.12±3.44 周，乌司奴单抗诱导的 BIBP 的潜伏期平均为 28.66±26.27 周。TNF-α 阻滞剂诱导的 BP 和乌司奴单抗诱导的 BP 在细胞因子途径和临床病程方面存在明显差异。在开始任何生物治疗之前，应建议银屑病患者仔细筛查既往大疱性疾病史，并进行基线免疫研究。在接受生物治疗的银屑病患者中，应高度建议密切监测皮肤状况。
