Time to Disease Control with Dupilumab for Bullous Pemphigoid: A Systematic Review and Meta-analysis

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Bullous pemphigoid (BP) is a chronic autoimmune blistering disease predominantly affecting elderly individuals.
• Current treatment guidelines await robust evidence from randomized clinical trials for dupilumab in BP.
• Clinicians are increasingly using dupilumab off-label for BP, necessitating data evaluation.

Purpose of the Study:

• To evaluate the efficacy of dupilumab in achieving disease control in bullous pemphigoid.
• To identify predictors of response to dupilumab treatment in BP patients.
• To assess disease recurrence and adverse events associated with dupilumab therapy.

Main Methods:

• A systematic review and meta-analysis of randomized and non-randomized studies of interventions (NRSIs) from Medline and Embase.
• Inclusion criteria focused on studies involving dupilumab for moderate-to-severe BP.
• Five NRSIs with 167 participants were included in the analysis.

Main Results:

• Dupilumab demonstrated a significant association with a shorter time to disease control compared to control groups (HR 2.71).
• The overall strength of evidence was graded as very low due to high risk of bias and imprecision.
• Insufficient data precluded conclusions on predictors of response, disease recurrence, and adverse events.

Conclusions:

• Evidence suggests dupilumab may reduce the time to achieve disease control in bullous pemphigoid.
• The current evidence base is limited, necessitating high-quality randomized controlled trials.
• Further research is required to establish dupilumab's definitive role in BP therapeutic strategies.