Long-term treatment outcomes and safety of dupilumab as a therapy for bullous pemphigoid: A multicenter retrospective review

To the Editor: Bullous pemphigoid (BP) is an autoimmune blistering disorder usually seen in elderly patients. Current therapies include corticosteroids, antibiotics, intravenous immunoglobulin, and immunosuppressants; however, some patients have exclusionary comorbidities, recalcitrant BP, or side effects of these medications. 1 Amber K.T. Murrell D.F. Schmidt E. Joly P. Borradori L. Autoimmune subepidermal bullous diseases of the skin and mucosae: clinical features, diagnosis, and management. Clin Rev Allergy Immunol. 2018; 54: 26-51https://doi.org/10.1007/s12016-017-8633-4 Crossref PubMed Scopus (130) Google Scholar Type 2 proinflammatory cytokines may play a role in the pathogenesis of BP and dupilumab, an interleukin 4 receptor-alpha antagonist, has been identified as a potential therapeutic agent. 1 Amber K.T. Murrell D.F. Schmidt E. Joly P. Borradori L. Autoimmune subepidermal bullous diseases of the skin and mucosae: clinical features, diagnosis, and management. Clin Rev Allergy Immunol. 2018; 54: 26-51https://doi.org/10.1007/s12016-017-8633-4 Crossref PubMed Scopus (130) Google Scholar , 2 Abdat R. Waldman R.A. de Bedout V. et al. Dupilumab as a novel therapy for bullous pemphigoid: a multicenter case series. J Am Acad Dermatol. 2020; 83: 46-52https://doi.org/10.1016/j.jaad.2020.01.089 Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar , 3 Muñoz-Bellido F.J. Moreno E. Dávila I. Dupilumab: a Review of present indications and off-label uses. J Investig Allergol Clin Immunol. 2022; 32: 97-115https://doi.org/10.18176/jiaci.0682 Crossref PubMed Scopus (41) Google Scholar Existing literature describes positive patients with BP response to dupilumab, but little information is available regarding long-term outcomes. 2 Abdat R. Waldman R.A. de Bedout V. et al. Dupilumab as a novel therapy for bullous pemphigoid: a multicenter case series. J Am Acad Dermatol. 2020; 83: 46-52https://doi.org/10.1016/j.jaad.2020.01.089 Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar ,4 Zhang Y. Xu Q. Chen L. et al. Efficacy and safety of dupilumab in moderate-to-severe bullous pemphigoid. Front Immunol. 2021; 12738907https://doi.org/10.3389/fimmu.2021.738907 Crossref Scopus (43) Google Scholar We evaluate response maintenance, treatment durability, and adverse events of patients with BP on dupilumab. This study was approved by Tufts Institutional Review Board.