Biologics in autoimmune bullous diseases: Current scenario

Abstract

Autoimmune bullous diseases can be intraepidermal (pemphigus group of disorders) or subepidermal (pemphigoid group of disorders). The treatment of these disorders chiefly comprises corticosteroids and immunosuppressant adjuvants like azathioprine and mycophenolate mofetil. Autoantibodies are the main mediators of these diseases. Rituximab, a chimeric anti-CD20 monoclonal antibody targeting B-cells, has emerged as an excellent treatment option for refractory pemphigus vulgaris in the last decade. Since then, many new biologics have been proposed/explored for managing autoimmune bullous diseases. These hold potential for greater efficacy and lesser adverse effects than conventional immunosuppressants. In this review, we discuss the role of various biologics in the treatment of autoimmune bullous diseases, followed by a brief discussion on the drawbacks to their use and new developments in this area.

Rituximab, Omalizumab, and Dupilumab Treatment Outcomes in Bullous Pemphigoid: A Systematic Review

“…One patient received complete remission by rituximab after the failure of omalizumab, five patients received complete remission by dupilumab after the failure of omalizumab, and one patient received partial remission by dupilumab after the failure of rituximab. This indicates the intricacies of the types of autoantibodies, their specific pathogenic actions, and the wide inherent inter-individual variations in BP ( 85 ). One patient received both omalizumab and dupilumab and achieved complete remission after 3 months of treatment and no recurrence was found after 10 months of follow-up.…”

Treatment of Bullous Pemphigoid With Dupilumab: A Case Series of 30 Patients

“…Tapering occurred on a case-With the further elucidation of humoral immune pathways and the advent of biologics, targeted therapy with rituximab, omalizumab, bertilimumab, and ixekizumab has been used in BP with success. 2 More recently, with the established importance of interleukin (IL)-4 and IL-13 cytokines in autoimmune blistering diseases, the IL-4Rα inhibitor, dupilumab, has risen as a plausible therapeutic option. 3 Several case reports and series have since demonstrated the efficacy of dupilumab in the treatment of BP and other blistering diseases.…”

“…This is beneficial as many traditional therapies used for BP carry toxic side effects and require more frequent monitoring. 2 Moreover, depending on patient responses, some maintenance dosing intervals were increased up to every 8 weeks, thus mitigating the risks and costs incurred with more frequent administration.…”

Successful Treatment of Bullous Pemphigoid Lesions by Berberine Stamp Therapy: A Case Report and Literature Review

“…Furthermore, according to Engineer et al, intravenous immunoglobulin is an alternative hormone therapy worth investigating because it is effective in the clinic, particularly in resistant BP, with minimal adverse reactions (23). Other treatment options, such as immunoadsorption (24), biological monoclonal antibodies (25), targeted therapy (26), and other approaches, are also worthy of further exploration. In addition to Western medicine treatment, traditional Chinese medicine treatment is currently receiving increasing attention, and its efficacy is considerable.…”