Omalizumab for Bullous Pemphigoid

Bullous pemphigoid is a rare skin condition and is mainly seen in older people. It starts with an itchy, raised rash and as the condition develops, large blisters are formed on the skin. The current treatment for bullous pemphigoid is not effective for many patients and this is where biologic drugs like dupilumab, ligelizumab, rituximab, and omalizumab, etc come in.

For now, let’s look at some case studies on how omalizumab can be effective for bullous pemphigoid.

1. The first case study shows that 6 patients with BP used omalizumab and the doctor checked in on them for up to 42 months.

5 of the 6 patients with BP received therapeutic benefits from systemic omalizumab with less use of other immunosuppressants, inhibition of new bullae, less pruritus, and decreases in eosinophil counts. The patients didn’t have any side effects from omalizumab.

2. This is a case of a 70-year-old whose bullous pemphigoid was successfully treated with omalizumab. He was presented with multiple bullae, eroded areas on the trunk, and extremities, particularly on the knees, hands, feet, and several oral erosions. The skin lesions were itchy and had progressed over the previous 3 months. Investigations also revealed a raised IgE level and eosinophilia.

Omalizumab therapy was started at a dose of 300 mg every 4 weeks as an alternative treatment (topical corticosteroids and other treatments were not effective). New lesions stopped appearing within 1 week of treatment and eroded areas gradually got covered. Several days after the omalizumab injections, thrombocytopenia was detected but, this did not require stopping the use of the drug, and the platelet count also gradually improved.

The platelet count fell after each omalizumab injection but gradually increased between successive injections (it never reached the normal range). 11 injections of omalizumab have been given to the patient. The immunoglobulin E level decreased just before the 12th dose.

This shows that omalizumab is effective for the treatment of bullous pemphigoid, but it is not approved by any regulatory authority.