Background
Bullous pemphigoid (BP) is an autoimmune blistering disease (AIB) characterized by subepidermal blisters with rising prevalence in elderly individuals. Besides B cells, Th2-type immune response and cytokines are important in the pathogenesis of BP. Treatments include topical orsystemic glucocorticoids and immunosuppressants. The latter are associated with side effects, especially increasedmortality. Dupilumab is a humanized monoclonal antibody targeting the IL-4Ralpha, therefore blocking IL-4 and IL-13 signaling. In Switzerland, it is approved for severe atopic dermatitis, CRSwNP and asthma. Especiallyin elderly patients Dupilumab might be an attractive treatment alternative for BP and other AIBs.
Observation
Herein, we report three cases of BP (3 males, mean age: 74 years) treated with dupilumab as a first- or second-line treatment. In all patients, a reduction in itch from an initial 10/10 to 2-4/10 was recorded within 24 hours and to 1-2/10 within two weeks. Bullous pemphigoid disease activity index (BPDAI) reduced from 30.6 (mean, range 21-39) within two weeks to 9.4 (mean, range 7-12). Levels of anti-BP180-IgG and anti-BP230-IgG and total IgE levels were not affected during this early timepoint, however, eosinophil counts reduced. Dupilumab therapywas well tolerated.
Conclusion:
In this small case series of dupilumab in BP we found that clinical response and itching was markedly reduced within a short observation time, which was also accompanied by an increased quality of life. Further research is needed to assess the safety and efficacy of dupilumab in patients with BP and other AIB disorders.

Dupilumab in the treatment of bullous pemphigoid

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