Omalizumab therapy for bullous pemphigoid

Abstract

Bullous pemphigoid (BP) responds to a variety of immunosuppressive agents and usually controls, but does not cure, the disease. Omalizumab, Food and Drug Administration-approved for asthma, selectively suppresses the activity of IgE, an important immunoglobulin in the pathogenesis of BP. We wished to determine if systemic omalizumab would have a therapeutic effect in patients with BP. We treated 6 patients with BP using omalizumab and followed up their disease for up to 42 months. Although variable, 5 of the 6 patients with BP received therapeutic benefit from systemic omalizumab (the sixth terminated treatment because of intercurrent illness) with less use of other immunosuppressants, inhibition of new bullae, less pruritus, and dramatic decreases in eosinophil counts. None of the patients had untoward side effects from omalizumab. This was an open, uncontrolled study. Omalizumab neutralizes the activity of IgE in patients with BP and improves the control of their disease activity.