Department of Dermatology, Hospital Doctor Peset, Valencia, Spain.
Department of Dermatology, Hospital Clinic, Barcelona, Spain.
Clin Exp Dermatol. 2024 Aug 22;49(9):1002-1006. doi: 10.1093/ced/llae067.
Bullous pemphigoid (BP) is the most common autoimmune blistering disease. Most patients are older and have associated multiple comorbidities. Topical and systemic corticosteroids are considered the first-line treatment for BP, and immunosuppressants are used as steroid-sparing treatments. However, both have side-effects and contraindications, which are even more common in this older population. New treatments targeting interleukins and receptors related to BP pathogenesis have been proposed to decrease these side-effects while achieving equal or better effectiveness and response rates. Omalizumab is a monoclonal antibody that targets IgE and has been proposed for the treatment of BP due to the evidence that IgE autoantibodies play an essential role in BP pathogenesis.
To assess the efficacy and safety of omalizumab for the treatment of BP.
We carried out a multicentre, retrospective, observational study including patients diagnosed with BP who received omalizumab for ≥ 3 months from 15 tertiary hospitals in Spain. IgE levels prior to treatment were measured, and we evaluated the possible correlation with clinical response. We excluded patients treated with omalizumab for < 3 months, as we consider this duration to be insufficient for a comprehensive assessment of its efficacy. To evaluate the effectiveness of the treatment, we used the percentage of body surface area improvement.
We included 36 patients. The vast majority had associated multiple comorbidities, and all patients had used other systemic therapies apart from corticosteroids before omalizumab. In total, 83% experienced some kind of treatment response and 42% of all patients treated achieved complete response. We did not find any correlation between higher IgE levels and a better response (P = 0.2). All patients tolerated omalizumab without reported side-effects.
Omalizumab is a good therapeutic alternative for BP as it provided clinical response in most patients, and nearly one-half of the cases achieved complete response. It showed no side-effects, which is crucial in older patients with BP.
大疱性类天疱疮（BP）是最常见的自身免疫性水疱病。大多数患者年龄较大，且伴有多种合并症。局部和全身皮质类固醇被认为是 BP 的一线治疗方法，免疫抑制剂则被用作皮质类固醇的节约治疗方法。然而，两者都有副作用和禁忌症，在这些老年患者中更为常见。新的治疗方法针对与 BP 发病机制相关的白细胞介素和受体，旨在减少这些副作用，同时实现等效或更好的有效性和反应率。奥马珠单抗是一种针对 IgE 的单克隆抗体，由于 IgE 自身抗体在 BP 发病机制中起着重要作用，因此被提议用于治疗 BP。
评估奥马珠单抗治疗 BP 的疗效和安全性。
我们进行了一项多中心、回顾性、观察性研究，纳入了来自西班牙 15 家三级医院的 36 名至少接受了 3 个月奥马珠单抗治疗的 BP 患者。在治疗前测量了 IgE 水平，并评估了其与临床反应的相关性。我们排除了治疗时间<3 个月的患者，因为我们认为这段时间不足以全面评估其疗效。为了评估治疗的有效性，我们使用了体表面积改善的百分比。
我们纳入了 36 名患者。绝大多数患者合并多种合并症，且所有患者在接受奥马珠单抗治疗之前都使用过其他全身性治疗方法，而不仅仅是皮质类固醇。总的来说，83%的患者经历了某种程度的治疗反应，42%的患者达到了完全缓解。我们没有发现更高的 IgE 水平与更好的反应之间存在相关性（P=0.2）。所有患者均耐受奥马珠单抗，未报告不良反应。
奥马珠单抗是 BP 的一种良好的治疗选择，因为它为大多数患者提供了临床反应，近一半的患者达到了完全缓解。它没有副作用，这在 BP 的老年患者中至关重要。
