Omalizumab in the management of bullous pemphigoid: a six-month retrospective study

Introduction: Bullous pemphigoid (BP) is the most common autoimmune bullous disease in older adults.However, these patients often require alternative treatments for BP due to comorbidities and use of multiple medications.Aim: To investigate the efficacy of omalizumab in BP patients. Material and methods:The records of patients with clinically, histopathologically, and serologically confirmed BP treated with omalizumab (300 mg monthly) and followed for at least 6 months were retrospectively reviewed.Treatment response was evaluated at 1, 3, and 6 months using the Bullous Pemphigoid Disease Area Index (BPDAI), Pruritus Visual Analogue Scale (PVAS), and treatment response scale (complete response [CR], partial response [PR], or nonresponse).Results: The study included 46 patients (45.7% males) with a mean age at diagnosis of 79.6 years.Before omalizumab treatment, the mean BPDAI was 18 (range: 3-51) and the mean PVAS score was 9 (range: 0-10).Thirteen (28.3%) patients required adjunctive systemic treatment (systemic steroid, azathioprine, dapsone, mycophenolate mofetil, rituximab, intravenous immunoglobulin) in addition to omalizumab.The rate of CR was 67.4% (n = 31) at 1 month and increased to 87% (n = 40) by 6 months.Patients without CR were older (p = 0.030).After omalizumab treatment, there were significant decreases in eosinophil (p < 0.001), total IgE (p = 0.002), and D-dimer (p < 0.001) levels.No adverse effects occurred during omalizumab treatment.Conclusions: BP patients responded well to omalizumab treatment and the CR rate increased with longer use.BPADI scores did not affect the treatment response.Omalizumab appears to be a safe option for BP, either alone or in combination therapy.