Omalizumab no Tratamento do Penfigóide Bolhoso - O Estado da Arte
Resumo
Introdução: Assistiu-se recentemente a um avanço significativo no conhecimento da fisiopatologia do penfigóide bolhoso, tendo sido demonstrado o papel patogénico dos auto-anticorpos anti-BP180 do subtipo IgE. O presente trabalho pretende explicitar os mecanismos patogénicos dos auto-anticorpos IgE no penfigóide bolhoso e discutir os dados publicados relativos à utilização clínica de omalizumab no seu tratamento.
Material e Métodos: Revisão de artigos em revistas com indexação na Medline/PubMed usando como termos de pesquisa “omalizumab bullous pemphigoid”.
Resultados: São revistas e discutidas 9 publicações, bem como como artigos relacionados, quando considerado pertinente. Na maioria dos casos, o omalizumab revelou-se um fármaco eficaz em seguro, sendo utilizado mais frequentemente como adjuvante a outras terapêuticas imunossupressoras. O papel de biomarcadores como IgE total ou contagem de eosinófilos na seleção de doentes ou monitorização do tratamento é ainda desconhecido.
Conclusões: A utilização de omalizumab no tratamento do penfigóide bolhoso é sustentada pela patogenicidade conhecida dos auto-anticorpos IgE específicos. A experiência clínica publicada é escassa, apontando o omalizumab como uma opção segura e eficaz no penfigóide bolhoso resistente à corticoterapia/imunossupressão. Por não condicionar imunossupressão, poderá constituir uma opção valiosa no tratamento do penfigóide bolhoso. São necessários estudos prospetivos aleatorizados, particularmente se comparativos com prednisolona oral em monoterapia.
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