Dupilumab Therapy for Bullous Pemphigoid in Elderly Patients

Introduction to Dupilumab Therapy

The British Journal of Dermatology recommends dupilumab as the first-line biologic choice for elderly patients with bullous pemphigoid, due to its superior evidence for efficacy and safety in this population, with a significant reduction in systemic glucocorticoid use by 82.1% by week 52 1, 2
The European guidelines suggest using topical clobetasol propionate 0.05% cream as first-line therapy for extensive disease, which can be used synergistically with dupilumab, providing superior disease control with lower mortality than systemic corticosteroids alone 1, 5, 4

The British Journal of Dermatology suggests starting dupilumab 600 mg subcutaneously, followed by 300 mg every 2 weeks, and considering concomitant topical clobetasol propionate 0.05% cream for extensive disease, which can be tapered after disease control 1, 5, 4
The British Journal of Dermatology recommends monitoring complete blood count, liver function, glucose, renal function, and blood pressure, and assessing disease activity at each visit, considering anti-BP180 IgG ELISA at days 0, 60, and 150 5, 4

The British Journal of Dermatology notes that dupilumab has an excellent safety profile, with only 12.6% of patients experiencing adverse events, most of which are mild, and no dupilumab-related adverse events were recorded in the comparative study with conventional therapy 1, 2
The British Journal of Dermatology suggests that if dupilumab is contraindicated or unavailable, the evidence-based hierarchy is topical clobetasol propionate 0.05% cream, doxycycline with nicotinamide, and azathioprine combined with low-dose prednisone, allowing a 45% reduction in steroid dose 1, 2, 6, 4