Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
Front Immunol. 2023 Jan 5;13:1050373. doi: 10.3389/fimmu.2022.1050373. eCollection 2022.
This study aimed to investigate the clinical features of biologics-induced bullous pemphigoid (BP) and the therapeutic effects of those agents for BP, exploring the underlying pathophysiological mechanisms.
We searched PubMed, Web of Science, and Elsevier for studies involving pemphigoid patients treated with or induced by identical biologics published in English from January 2009 to April 2022.
Seventeen cases of drug-induced BP associated with anti-tumor necrosis factor (aTNF)-α therapies, one with interleukin (IL)-17 inhibitors, and seven with IL-12/IL-23 or IL-23 inhibitors were enrolled. Time to cutaneous toxicity varied among different types of agents, and the characteristics of clinical examinations were similar to idiopathic BP. Discontinuation of the culprit drugs and initiation of topical or systemic corticosteroids were adequate in most cases. Several monoclonal antibodies above have also been reported for the treatment of refractory or recurrent BP, especially concurrent with psoriasis.
Biologics for immune-related diseases, including TNF-α, IL-17, and IL-12/IL-23 or IL-23 inhibitors, can both induce and treat BP, which might be associated with a helper T cells Th1/Th2 imbalance, complicated inflammatory networks, and a specific individual microenvironment, suggestive of a new perspective on the therapeutic algorithms of BP. There have been numerous reports about biologics inducing or treating BP. We have taken note of this phenomenon and focused on biologics with both pathogenetic and therapeutic effects on BP. Our review summarized the clinical characteristics of associated cases, trying to figure out the underlying mechanisms of this paradoxical phenomenon and to provide an integrated perspective and new therapeutic alternatives for BP.
本研究旨在探讨生物制剂诱导性大疱性类天疱疮（BP）的临床特征及这些药物治疗 BP 的疗效，探索其潜在的病理生理机制。
我们检索了 2009 年 1 月至 2022 年 4 月期间发表的在英文期刊上涉及使用相同生物制剂治疗或诱导发生 BP 的病例研究，检索数据库包括 PubMed、Web of Science 和 Elsevier。
共纳入 17 例与抗肿瘤坏死因子（aTNF）-α 治疗相关的药物诱导性 BP 病例、1 例与白细胞介素（IL）-17 抑制剂相关的 BP 病例、7 例与 IL-12/IL-23 或 IL-23 抑制剂相关的 BP 病例。不同类型药物引起皮肤毒性的时间不同，临床表现特征与特发性 BP 相似。大多数情况下，停用致病药物并开始使用局部或全身皮质类固醇即可。此外，还有几种单克隆抗体也被报道用于治疗难治性或复发性 BP，尤其是合并银屑病的情况。
包括 TNF-α、IL-17 和 IL-12/IL-23 或 IL-23 抑制剂在内的免疫相关疾病生物制剂既可以诱导也可以治疗 BP，这可能与辅助性 T 细胞 Th1/Th2 失衡、复杂的炎症网络以及特定的个体微环境有关，提示 BP 治疗方案有了新的视角。已有大量关于生物制剂诱导或治疗 BP 的报道。我们注意到了这一现象，并关注对 BP 具有致病和治疗作用的生物制剂。我们的综述总结了相关病例的临床特征，试图找出这一矛盾现象的潜在机制，并为 BP 提供综合的视角和新的治疗选择。
