Rituximab and omalizumab therapy shows promise against Bullous pemphigoid: JAMA

The team led by Stephanie at the University of California Davis reported a remarkable 70% durable complete response rate in a case series of 10 patients with the rare immunobullous disease known as bullous pemphigoid (BP). The breakthrough lies in the combination of rituximab (RTX) and omalizumab (OMZ). The findings were published in JAMA Dermatology.

Bullous pemphigoid is a challenging condition with no FDA-approved treatment available, has seen mixed results with existing therapies. Rituximab, while effective in some cases, often falls short due to its limited impact on serum IgE levels. On the other hand, omalizumab, targeting IgE, offers faster action but has demonstrated varied effectiveness.

The study spanned from 2015 to 2022 found the synergistic potential of RTX+OMZ therapy. The retrospective review of electronic medical records focused on adult patients with a confirmed BP diagnosis who received simultaneous treatment with RTX and OMZ.

The findings indicated that the high-dose OMZ cohort achieved a remarkable 100% complete remission in a mean duration of 2.1 months. Even in the low-dose OMZ group, all patients improved, though none reached complete remission. Patients who tapered OMZ dosage experienced flare-ups, emphasizing the importance of sustained treatment.

This research challenges the conventional perceptions of BP as an IgG-mediated disease by highlighting the role of high circulating IgE in up to 85% of patients. This combination therapy targeted both IgG and IgE, proved well-tolerated with mild adverse effects and also accelerated time to remission.

While the study underscores the potential of RTX+OMZ in refractory BP cases, the outcomes emphasize the need for larger controlled studies to establish its efficacy compared to other therapies. The findings not just paves way for further exploration of combination therapies in managing rare skin diseases but also, offers hope for patients unresponsive to conventional treatments.

Source:

Le, S. T., Herbert, S., Haughton, R., Nava, J., Toussi, A., Ji-Xu, A., & Maverakis, E. (2023). Rituximab and omalizumab combination therapy for bullous pemphigoid. JAMA Dermatology (Chicago, Ill.). https://doi.org/10.1001/jamadermatol.2023.4508