Efficacy and safety of dupilumab in patients with moderate-to-severe bullous pemphigoid: a systematic review and meta-analysis.

Objective: Evaluate the safety and efficacy of dupilumab in treating moderate-to-severe bullous pemphigoid.

Methods: The authors performed a systematic review and meta-analysis of comparative studies of Dupilumab combined with corticosteroids and conventional corticosteroid therapy alone in patients with moderate-to-severe bullous pemphigoid. PubMed, Embase and Cochrane databases were searched for studies published up to December 2023. Data were extracted from published reports and quality assessment was performed according to Cochrane recommendations.

Results: A total of four studies involving 127 patients were included, of which 53 received Dupilumab combined with corticosteroids, while the other 74 were administered corticosteroids alone. Regarding efficacy, Dupilumab the time before new blister formation stopped (MD = -5.13 days; 95% CI -7.12 to -3.15; p < 0.0001) and demonstrated a greater reduction in Bullous Pemphigoid Disease Area Index (MD = -3.90; 95% CI -5.52 to -2.27; p < 0.0001) and Numeric Rating Scale for Pruritus (SMD = -1.37; 95% CI -2.02 to -0.72; p < 0.0001) compared with patients who received conventional therapy. However safety endpoints, adverse events (RR = 0.78; 95% CI 0.58 to 1.05; p = 0.10) and relapses (RR = 0.50; 95% CI 0.19 to 1.36; p = 0.17) showed no significance. The main limitations were retrospective studies with small samples and limited results in clinical practice and a moderate overall risk of bias.

Conclusion: Compared with conventional therapy, Dupilumab decreased the time before new blister formation stopped in 5.13 days, as well as Disease Area Index and Pruritus, without interfering with adverse events and relapse.