度普利尤单抗治疗大疱性类天疱疮21例的疗效及安全性回顾分析

Efficacy and safety of dupilumab in the treatment of 21 cases of bullous pemphigoid:a retrospective study

目的回顾分析度普利尤单抗治疗大疱性类天疱疮的疗效及安全性。方法回顾收集2020年10月至2021年10月于北京大学第一医院皮肤科就诊使用度普利尤单抗治疗(首次600 mg,后每2周300 mg,必要时提高注射频率)的大疱性类天疱疮患者临床资料,分析其临床表现及实验室指标变化情况。结果共纳入21例使用度普利尤单抗治疗的大疱性类天疱疮患者,19例(90.5%)在使用度普利尤单抗治疗2周内达到疾病完全或大部分控制;12例患者随访时间达到16周,均在治疗16周时仍可保持疾病完全控制。所有患者基线BPDAI评分为(122.5±51.1)分,度普利尤单抗治疗2周后下降至(30.6±27.4)分(t=8.53,P<0.001),并在治疗4周时继续下降至(12.7±9.1)分(t=9.73,P<0.001)。21例患者均在使用度普利尤单抗治疗后4周内瘙痒明显缓解。在基线嗜酸性粒细胞计数升高的10例患者中,9例治疗后明显下降。在基线血清IgE浓度升高的7例患者中,6例治疗后明显下降。1例(4.8%)出现病毒性结膜炎,其他患者未见不良反应发生。结论度普利尤单抗可有效控制大疱性类天疱疮的病情,明显缓解瘙痒症状,安全性好。

Objective To retrospectively analyze the efficacy and safety of dupilumab in the treatment of bullous pemphigoid(BP).Methods Clinical data were collected from BP patients who received injections of dupilumab at an initial dose of 600 mg followed by an every-2-week regimen at a dose of 300 mg(the frequency of injections could be increased if necessary)in Department of Dermatology,Peking University First Hospital from October 2020 to October 2021,and their clinical manifestations and changes in laboratory indices were analyzed.Results A total of 21 BP patients treated with dupilumab were included in this study.Nineteen(90.5%)patients achieved complete or marked disease control after 2-week treatment with dupilumab;12 patients were followed up for 16 weeks,and all maintained complete disease control at 16 weeks.All patients had a bullous pemphigoid disease area index(BPDAI)score of 122.5±51.1 points at baseline,which decreased to 30.6±27.4 points after 2-week treatment with dupilumab(t=8.53,P<0.001),and continued to decrease to 12.7±9.1 points after 4-week treatment(t=9.73,P<0.001).Pruritus was markedly relieved in all the 21 patients within 4-week treatment with dupilumab.Among 10 patients with elevated eosinophil counts at baseline,the eosinophil counts markedly decreased in 9 after treatment.The serum IgE level was elevated in 7 patients at baseline,which markedly decreased in 6 after treatment.Viral conjunctivitis occurred in 1(4.8%)patient,and no adverse reactions were observed in other patients.Conclusion Dupilumab is effective in the control of BP and relief of pruritus,with a favorable safety profile.