Rituximab and Omalizumab for the Treatment of Bullous Pemphigoid: A Systematic Review of the Literature

Kremer, Noa; Snast, Igor; Cohen, Efrat Solomon; Hodak, Emmilia; Mimouni, Daniel; Lapidoth, Moshe; Mazor, Sigal; Levi, Assi

doi:10.1007/s40257-018-0401-6

Cited by 99 publications

(98 citation statements)

References 47 publications

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“…These may include omalizumab or rituximab (bullous pemphigoid), narrowband ultraviolet therapy, anti-TNF agents, methotrexate, acitretin or apremilast (psoriasis), systemic corticosteroids or retinoids (lichenoid reactions), or, as recently suggested, biologic immunomodulatory therapies including with mAbs targeting IL-4 (dupilumab) or IL-6 (tocilizumab) for severe or persistent rashes. 26,34 Finally, the occurrence of most dermatological toxicities (with the possible exception of pruritus without rash) can be considered as a positive prognostic factor and appears to be correlated with a better progression-free or overall survival. 22,35 Renal toxicities Immune-mediated kidney disease is a rare complication of ICI therapy.…”

Section: Dermatologic Toxicitiesmentioning

confidence: 99%

Balancing Cancer Immunotherapy Efficacy and Toxicity

Johnson

Jakubovic

Sibaud

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Section: Dermatologic Toxicitiesmentioning

confidence: 99%

Balancing Cancer Immunotherapy Efficacy and Toxicity

Johnson

Jakubovic

Sibaud

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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“…Rituximab (anti-CD20) also led to 85% complete responses in BP (in 62 patients). Rituximab was associated with lower recurrence rates and a longer disease-free period compared to omalizumab (60). Patients that first did not respond to omalizumab but improved using rituximab (61), but also cases with improvement on omalizumab after failure to rituximab have been published.…”

Section: Bullous Disorders: Bullous Pemphigoid (Bp) and Other Bullousmentioning

confidence: 99%

Learning From Success and Failure: Biologics for Non-approved Skin Diseases

2019

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The impressive potential of biologics has been demonstrated in psoriasis, hidradenitis suppurativa, and urticaria. Numerous biologicals are entering the field for a restricted number of skin disorders. Off-label use of biologics in other recalcitrant skin diseases has increased. Mounting data point to the potential of already existing biologics acting on the IL-17/IL-23 pathway in skin disorders with epidermal hyperkeratosis (e.g., pityriasis rubra pilaris), acneiform inflammation (e.g., hidradenitis suppurativa), and loss of mucosal integrity (e.g., aphthosis). TNF-α blockers are also effective in the latter conditions but seem of particular value in granulomatous (e.g., granuloma annulare) and neutrophilic disorders (e.g., pyoderma gangrenosum). Failure of IL-17 blockade in skin diseases resulting from immune-mediated cell destruction (e.g., alopecia areata and vitiligo) illustrates its limited involvement in Th1-dependent skin immunology. Overall, disappointing results of TNF-α blockers in alopecia areata and vitiligo point to the same conclusion although promising results in toxic epidermal necrolysis suggest TNF-α exerts at least some in vivo Th1-related activities. Acting on both the Th1 and Th17 pathway, ustekinumab has a rather broad potential with interesting results in lupus and alopecia areata. The efficacy of omalizumab in bullous pemphigoid has revealed an IgE-mediated recruitment of eosinophils leading to bullae formation. Reconsidering reimbursement criteria for less common but severe diseases seems appropriate if substantial evidence is available (e.g., pityriasis rubra pilaris). For other disorders, investigator-and industry-initiated randomized clinical trials should be stimulated. They are likely to improve patient outcome and advance our understanding of challenging skin disorders.

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“…High-affinity IgE receptors (FcεRI) that are highly expressed on eosinophils in BP patients could enhance the capability of eosinophils to bind IgE and thus influence their subsequent degranulation (138). In recent reports, the monoclonal anti-IgE antibody omalizumab resulted effective in treating patients affected with BP, despite ongoing high levels of anti-skin IgG antibodies (139, 140). This provides further evidence of an independent role for autoreactive IgE-mediated inflammation in BP skin lesion development.…”

Section: Bullous Pemphigoidmentioning

confidence: 99%

Coagulation and Skin Autoimmunity

et al. 2019

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Several lines of evidence indicate that the immune system, inflammation, and coagulation are simultaneously activated in autoimmune and immune-mediated skin diseases. Pro-inflammatory cytokines such as interleukin-6 and tumor necrosis factor-alpha induce the expression of the main initiator of coagulation, i.e., tissue factor. The proteases of coagulation in turn act on protease-activated receptors inducing the expression of various pro-inflammatory cytokines triggering inflammation. The cross-talk among immune system, inflammation, and coagulation amplifies and maintains the activation of all three pathways. This review focuses on three skin disorders as chronic spontaneous urticaria (CSU), angioedema, and bullous pemphigoid (BP), in which the relationships among the three systems have been investigated or their clinical consequences are relevant. Markers of thrombin generation, fibrinolysis, and inflammation have been reported to be increased in the plasma during flares of CSU and angioedema, as well as in the active phase of BP, with the marker levels reverting to normal during remission. The coagulation activation seems to be important only at local level in CSU and angioedema while both at local and systemic levels in BP which is the only condition associated with an increased thrombotic risk. The prothrombotic state in autoimmune skin diseases raises the question of the indication of anticoagulant treatment, particularly in the presence of other cardiovascular risk factors.

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Rituximab and Omalizumab for the Treatment of Bullous Pemphigoid: A Systematic Review of the Literature

Cited by 99 publications

References 47 publications

Balancing Cancer Immunotherapy Efficacy and Toxicity

Balancing Cancer Immunotherapy Efficacy and Toxicity

Learning From Success and Failure: Biologics for Non-approved Skin Diseases

Coagulation and Skin Autoimmunity

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