Thevan Jeivicaa, Schmauch Eloi, Nilsson Jakob, Guillet Carole Florence, Boesch Andrea, Krähenbühl Lukas, Meier-Schiesser Barbara, Schmid-Grendelmeier Peter, Kündig Thomas, Kolios Antonios G A
Department of Dermatology, University Hospital Zurich, Zurich, Switzerland,
Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
Dermatology. 2024;240(5-6):694-701. doi: 10.1159/000540590. Epub 2024 Jul 29.
Dupilumab has emerged as a promising treatment option for bullous pemphigoid (BP). Rapid identification of responders could avoid the need for additional immunosuppressive treatments that are associated with increased morbidity and mortality.
To investigate the course of itch as an early indicator of treatment response, data of 12 BP patients treated with dupilumab at the University Hospital of Zurich were retrospectively evaluated. Disease severity was assessed by bullous pemphigoid disease area index (BPDAI) and pruritus by a numeric rating scale (NRS, 0-10) at baseline; days 1, 3, 14; months 1, 2; and the last follow-up.
A total of 8/12 patients (67%) had complete response, and 4/12 patients (33%) had partial response during dupilumab treatment. Notably, a highly significant reduction of pruritus (p < 0.0001) was observed already on day 1 with further improvement at later time points. Moreover, fast relief of itch could predict treatment response with a significant correlation to clinical response on day 14 (Spearman correlation R 0.70, p value 0.025), with a positive but non-significant trend on day 3 (R 0.63, p value 0.091). Additionally, 92% (11/12 patients) were on dupilumab monotherapy at the last follow-up without any concomitant systemic or topical treatment for BP.
The rapid and significant decline in BP-associated pruritus observed with dupilumab correlated significantly with disease remission. Early evaluation of pruritus response could change how BP is treated in the future and avoid additional immunosuppressive treatment in BP.
度普利尤单抗已成为大疱性类天疱疮（BP）一种有前景的治疗选择。快速识别反应者可避免使用与发病率和死亡率增加相关的额外免疫抑制治疗。
为了研究瘙痒过程作为治疗反应的早期指标，对苏黎世大学医院接受度普利尤单抗治疗的12例BP患者的数据进行了回顾性评估。在基线、第1天、第3天、第14天、第1个月、第2个月以及最后一次随访时，通过大疱性类天疱疮疾病面积指数（BPDAI）评估疾病严重程度，通过数字评分量表（NRS，0 - 10）评估瘙痒程度。
在度普利尤单抗治疗期间，共有8/12例患者（67%）完全缓解，4/12例患者（33%）部分缓解。值得注意的是，在第1天就观察到瘙痒显著减轻（p < 0.0001），在随后的时间点进一步改善。此外，瘙痒的快速缓解可预测治疗反应，与第14天的临床反应显著相关（Spearman相关性R 0.70，p值0.025），在第3天呈阳性但不显著趋势（R 0.63，p值0.091）。此外，在最后一次随访时，92%（11/12例患者）接受度普利尤单抗单药治疗，未进行任何针对BP的全身或局部治疗。
度普利尤单抗治疗BP时观察到的与疾病相关的瘙痒迅速且显著下降与疾病缓解显著相关。对瘙痒反应的早期评估可能会改变未来BP的治疗方式，并避免在BP中使用额外的免疫抑制治疗。
