Omalizumab in the Treatment of Bullous Pemphigoid - State of the Art
Abstract
Introduction: There has been a significant advance in the understanding of the pathophysiology of bullous pemphigoid, particularly after demonstrating a pathogenic role for anti-BP180 IgE autoantibodies. Omalizumab is a monoclonal antibody that blocks free IgE and, in the last years, several cases of omalizumab-treated bullous pemphigoid have been published. This paper aims to clarify the pathogenic mechanisms of IgE autoantibodies in bullous pemphigoid and to discuss the clinical use of omalizumab based on the published clinical experience.
Methods: Review of published articles in Medline/PubMed indexed journals using "bullous pemphigoid omalizumab" as search terms. Results: We review and discuss nine publications and related papers, when considered relevant by authors. In most cases, omalizumab seems to be an effective and safe drug in the treatment of bullous pemphigoid, being used more often as adjunct to other immunosuppressive agents. The role of biomarkers such as total IgE and eosinophil count in the selection of patients or treatment monitoring is still unknown.
Conclusions: The use of omalizumab for the treatment of bullous pemphigoid is supported by the thoroughly studied pathogenicity of specific IgE autoantibodies. The published clinical experience is scarce, pointing omalizumab as a safe and effective option in bullous pemphigoid resistant to corticosteroids/immunosuppression. Because it is not an immunossupressive drug, omalizumab may be a valuable option in the treatment of bullous pemphigoid. Prospective randomized trials are warranted, particularly comparative studies with oral prednisolone in monotherapy.
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