Effectiveness of Dupilumab and Omalizumab in Bullous Pemphigoid: A Nationwide Retrospective Cohort Study

Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease worldwide. In the difficult-to-treat BP or if standard therapies are contraindicated, the use of biologics may be also considered although there is no strong evidence supporting their use. This study aimed to investigate clinical and diagnostic findings as well as treatment outcomes among patients diagnosed with BP and undergoing omalizumab or dupilumab in a real-world setting. A multicenter retrospective cohort study was performed across 15 Italian tertiary referral hospital. Medical records of 2435 BP patients were screened, identifying 58 (2.3%) Caucasian patients who met the inclusion criteria. Within this study population, 39 (67.2%) were treated with dupilumab and 19 (32.8%) received omalizumab. Disease control was achieved in 90.6% of dupilumab-treated patients and complete remission on minimal therapy was observed in 71.0%. Omalizumab-treated patients achieved disease control in 77.8% of cases and 64.7% obtained complete remission on minimal therapy. Log-rank test comparing relapse rate between treatment groups was not significant (p = 0.58). Finally, parameter estimates associated with the fixed effect of time were consistently negative, indicating a generally significant (p = < 0.05) decrease in scores over time for patients treated with both biologics. This cohort of patients undergoing dupilumab or omalizumab adds to the existing evidence concerning the effectiveness of biologic agents in BP. Both biologics seem to be promising treatment adjuvants in the management of BP, with dupilumab showing a descriptive trend toward better outcomes.