Increasing Evidence for Omalizumab in the Treatment of Bullous Pemphigoid
Sarah Lonowski, MD, MBA, Division of Dermatology, University of California Los Angeles, Los Angeles, California
Disclosures: None.
Sarah Lonowski, MD, MBA
Introduction
Bullous pemphigoid (BP) is a common, debilitating autoimmune blistering disease which is often managed with prednisone and other systemic immunosuppressive medications. Here, we present the largest case series to date evaluating the use of omalizumab for the treatment of BP, providing novel insight and further support for use of this well-tolerated, minimally immunosuppressive agent.
Objective
To review and analyze the experience of patients with BP treated with omalizumab at a single academic institution.
Methods
Retrospective chart analysis of eleven patients with BP treated at a single academic institution over a 32-month period (April 2016–December 2018). Data was obtained through comprehensive review of pathology reports, laboratory data, and physician documentation. Standard descriptive statistics were performed on the data.
Results
Eleven patients were included in the analysis, 5 females (45.5%) and 6 males (54.5%) with a mean age of 78 years (range, 57-95 years). Patients had failed a mean of 2.3 systemic agents prior to initiation of omalizumab. Seven of 11 patients (63.6%) had experienced adverse effects related to prednisone prior to initiation of omalizumab. Six patients (54.5%) had complete clearance of skin lesions after a median duration of 4.4 months on omalizumab, 3 patients (27.3%) had partial response, and 2 patients (18.2%) did not respond to treatment. The median duration of treatment in all patients at the time of analysis was 12.6 months. All 10 patients on prednisone at the time of omalizumab initiation were able to reduce the dose of prednisone, and 5 of 10 patients (50%) were able to discontinue systemic steroids completely. Baseline serum immunoglobulin E (IgE) and eosinophil levels did not predict treatment response. There were no serious treatment-related adverse effects during the treatment period.
Conclusions/Relevance
Omalizumab is a well-tolerated, steroid-sparing agent which has a significant disease-modifying effect in the majority of patients. Baseline serum IgE and eosinophil levels do not appear to predict treatment response, therefore patient selection should not hinge on these lab values. Omalizumab should be considered as a treatment option for any patient requiring systemic treatment for BP, but especially for those who have experienced or are at risk for experiencing adverse effects from systemic steroids.