Omalizumab in the treatment of bullous pemphigoid: A single-center series of 15 cases

Abstract

Bullous pemphigoid (BP) is a chronic autoimmune disease affecting the elderly population and characterized by the formation of subepidermal tense bullae. Treatment options include topical steroids, systemic steroids, immunosuppressants, and antimicrobials, and there is emerging evidence of the efficacy of omalizumab. In this study, we aimed to demonstrate omalizumab's efficacy for treating BP, and we also reported treatment-related adverse events. The retrospective cohort study included patients with BP who were followed up in our clinic's bullous diseases department between 2016 and 2023. Patients who received omalizumab were included in the study. Treatment responses of all patients were assessed by BP Disease Area Index activity and damage scores, treatment scale scoring, steroid dose reduction, and the presence/absence of pruritus. Also, total IgE levels of patients before the treatment onset and at the last visit were compared. There were 15 (male/female = 8/7) BP patients receiving omalizumab treatment. Omalizumab therapy allowed steroid dose reduction at a median of 1 month. Omalizumab (25.5 mg, 95% confidence interval 17.2-33.9, P < .001) provided a significant steroid dose reduction at the last visit compared to the beginning of treatment. Omalizumab resulted in a decrease in BP Disease Area Index activity score of 80.8 (95% confidence interval 71.8-89.8, P < .001). Also, omalizumab caused significant decline in IgE levels compared to baseline (1102.5 ± 834.5 vs 834.6 ± 613.6, P = .002). In this study, omalizumab treatment was an effective and safe option in BP patients with high baseline IgE levels who are refractory to or cannot tolerate other immunosuppressive therapies.

Figure 1.

Response of BPDAI activity score after OMA treatment. OMA resulted in a mean reduction in BPDAI activity score of 80.8 (95% CI 71.8–89.8) from baseline (P < .001). BPDAI = Bullous Pemphigoid Disease Area Index, OMA = omalizumab.

Figure 2.

Reduction in steroid dosage after OMA treatment. OMA resulted in a mean steroid dose reduction of 25.5 mg (95% CI 17.2–33.9) from baseline (P < .001). OMA = omalizumab.

Figure 3.

Decline in serum total IgE levels after OMA treatment. OMA provided a mean 268 (95% CI 48.7–487.3) decline in serum total IgE levels compared to baseline (P = .002). IgE = immunoglobulin E, IU = international unit, OMA = omalizumab.