Omalizumab in the management of bullous pemphigoid: a six-month retrospective study

Introduction
Bullous pemphigoid (BP) is the most common autoimmune bullous disease in older adults. However, these patients often require alternative treatments for BP due to comorbidities and use of multiple medications.

Aim
To investigate the efficacy of omalizumab in BP patients.

Material and methods
The records of patients with clinically, histopathologically, and serologically confirmed BP treated with omalizumab (300 mg monthly) and followed for at least 6 months were retrospectively reviewed. Treatment response was evaluated at 1, 3, and 6 months using the Bullous Pemphigoid Disease Area Index (BPDAI), Pruritus Visual Analogue Scale (PVAS), and treatment response scale (complete response [CR], partial response [PR], or nonresponse).

Results
The study included 46 patients (45.7% males) with a mean age at diagnosis of 79.6 years. Before omalizumab treatment, the mean BPDAI was 18 (range: 3–51) and the mean PVAS score was 9 (range: 0–10). Thirteen (28.3%) patients required adjunctive systemic treatment (systemic steroid, azathioprine, dapsone, mycophenolate mofetil, rituximab, intravenous immunoglobulin) in addition to omalizumab. The rate of CR was 67.4% (n = 31) at 1 month and increased to 87% (n = 40) by 6 months. Patients without CR were older (p = 0.030). After omalizumab treatment, there were significant decreases in eosinophil (p < 0.001), total IgE (p = 0.002), and D-dimer (p < 0.001) levels. No adverse effects occurred during omalizumab treatment.

Conclusions
BP patients responded well to omalizumab treatment and the CR rate increased with longer use. BPADI scores did not affect the treatment response. Omalizumab appears to be a safe option for BP, either alone or in combination therapy.