Dual‐Biologic Therapy in Refractory Bullous Pemphigoid: A Focused Review of Rituximab–Omalizumab and Omalizumab–Dupilumab

Le résumé fourni par la source

Background Bullous pemphigoid (BP) is the commonest autoimmune subepidermal blistering disease. Refractory cases and patients with comorbidities limiting conventional immunosuppression remain difficult to treat. Dual‐biologic therapy has emerged as a rescue strategy. Methods We reviewed PubMed and Embase from inception to 1 April 2026 for reports of overlapping dual‐biologic therapy in BP. Six peer‐reviewed studies describing rituximab plus omalizumab (ROCT) or omalizumab plus dupilumab (DOCT) were included for descriptive synthesis. Results Six studies comprising 37 patients were identified (27 ROCT and 10 DOCT). In the largest comparative ROCT cohort, all 17 combination‐treated patients achieved disease control versus 23 of 25 (92%) receiving rituximab alone, with faster disease control (15 vs. 67.5 days) and lower 60‐day methylprednisolone exposure (698.4 vs. 1087.4 mg). High‐dose omalizumab plus rituximab achieved complete remission in 7 of 7 patients. DOCT showed favorable responses but remained small, uncontrolled, and partly confounded by concomitant mycophenolate mofetil in 3 of 10 patients. No treatment‐attributable combination‐specific safety signal was identified. Conclusions Dual‐biologic therapy in BP was concentrated in ROCT and DOCT pairings, used mainly in refractory disease or when conventional immunosuppression was constrained by comorbidity. ROCT carries the stronger signal, whereas DOCT remains promising but exploratory. Prospective multicenter studies are needed.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.