Efficacy and safety of biological agents for pemphigoid: a systematic review and meta‐analysis

Abstract Biologic agents (also termed biologics) have become an important adjuvant‐targeted treatment option in autoimmune blistering disease. We evaluated the efficacy and safety of newly licensed biologics for the management of pemphigoid using a meta‐analysis. PubMed, EMBASE, Web of Science, and the Cochrane Library for studies involving pemphigoid patients treated with biological agents (rituximab, dupilumab, omalizumab, or mepolizumab) were searched. The pooled risk ratio (RR) with a 95% confidence interval (CI) was used to assess the short‐term efficacy, adverse event (AE), relapse, and long‐term survival. A total of seven studies involving 296 patients were identified. The pooled RRs for short‐term effectiveness, AE, relapse, and long‐term survival rate in patients treated with biological agents versus systemic corticosteroids were 1.37 (95% CI 0.95–1.97; I 2 = 82%; P = 0.09), 0.54 (95% CI 0.39–0.73; I 2 = 13%; P = 0.005), 1.36 (95% CI 0.95–1.96; I 2 = 16.8%; P = 0.19), and 1.08 (95% CI 0.95–1.21; I 2 = 48.1%; P = 0.53), respectively. Meta‐regression and subgroup analysis revealed that the RRs of efficacy were 2.10 (95% CI 1.61–2.75; I 2 = 0%; P < 0.00001) for rituximab and 2.07 (95% CI 1.61–2.67; I 2 = 0%; P < 0.00001) for sample size greater than 30. Compared with conventional therapy, biologics treatment was significantly associated with fewer adverse events ( P < 0.05), but no significant differences were found for efficacy and relapse ( P > 0.05). The findings demonstrate that a biologics‐containing regimen could minimize the occurrence of AEs and might display a comparable efficacy and recurrence to that of receiving systemic corticosteroids.