Clinical effect of omalizumab as an adjuvant treatment to rituximab in patient with refractory bullous pemphigoid

Patients with refractory bullous pemphigoid (BP) achieve remission after rituximab treatment but require high-dose systemic corticosteroids until the remission. The aim of this retrospective study was to examine the clinical efficacy of omalizumab as an adjuvant treatment to rituximab in patients with refractory BP. Patients with BP receiving treatment with either rituximab monotherapy or rituximab plus omalizumab were considered for the study. The total dose of corticosteroids received for 60 days after administration of rituximab, mortality and relapse rates, and median time to relapse were also investigated. Of 49 patients included in the study, 25 received rituximab monotherapy and 17 received the combination therapy with rituximab and omalizumab. The rituximab plus omalizumab group showed shorter time to disease control with minimal treatment (15 days vs. 67.5 days, p < 0.001) and lower corticosteroid dose for 60 days after administration of rituximab (698.4 mg vs. 1087.4 mg of methylprednisolone, p < 0.001) compared to the rituximab monotherapy group. The results of this study suggest that combination therapy with rituximab and omalizumab can achieve disease control status faster than the rituximab monotherapy, reducing the total dose of corticosteroids.