Omalizumab and Dupilumab for the Treatment of Bullous Pemphigoid: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Objectives
2.2. Search Strategy
2.3. Inclusion and Exclusion Criteria
2.4. Selection of Studies
2.5. Research Questions
- What profile do patients with BP treated with biological drugs have?
- How effective are omalizumab and dupilumab in the treatment of BP?
- What is the safety and side effect profile of omalizumab and dupilumab in patients with BP?
2.6. Variables
- Clinical and sociodemographic variables related to the characteristics of BP in patients treated with omalizumab/dupilumab, as well as the existence of comorbidities and other autoimmune diseases.
- Variables related to the therapeutic management carried out (treatment administered, dosage).
- Variables related to the effectiveness of treatment with omalizumab and dupilumab in BP. The rate of complete response of patients under treatment in the assessed studies was collected.
- Variables related to the safety of treatments.
2.7. Assessment of the Quality of the Scientific Evidence
- 1a: Evidence obtained from systematic reviews or meta-analysis of randomized controlled clinical trials.
- 1b: Evidence obtained from individual randomized controlled clinical trials.
- 2a: Evidence obtained from systematic reviews or meta-analysis of cohort studies.
- 2b: Evidence obtained from individual cohort studies.
- 3a: Evidence obtained from systematic reviews or meta-analysis of case-control studies.
- 3b: Evidence obtained from individual case-control studies.
- 4: Evidence obtained from case series.
- 5: Evidence obtained from expert opinions.
2.8. Statistical Analysis
3. Results
3.1. Sociodemographic and Clinical Characteristics of Patients with BP Treated with Omalizumab and Dupilumab
3.2. Effectiveness of BP Treatment with Omalizumab/Dupilumab
3.3. Side Effects of Treatment with Omalizumab/Dupilumab
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Study | Type of Study | Number of Patients | Dose Used | Previous Treatments | Results Obtained | Side Effects | Observations | Level of Evidence |
---|---|---|---|---|---|---|---|---|
“Cao P et al. (2022)” [23] | Systematic review 75 studies included | 211 patients with BP, 53 treated with omalizumab, 122 with RTX and 36 with dupilumab | NE, average treatment duration 6.6 months | CTC, MTX, MMF, AZA, CLP, CFF | Complete BP remission in 67.9% of patients (36/56) and partial remission in20.8% (11/53) | Recurrence 5.7% (3/53) Death due to thrombocytopenia(1.9%, 1/53) | The rest of the patients included in the study (122) were treated with RTX, giving a higher number of recurrences, AEs and mortality | 2a |
“Oren-Shabtai M et al. (2023)” [22] | Presentation of 9 cases | 9, 3 of them treated with omalizumab, 7 with RTX and 1 with dupilumab, average age 60.4 years | 300 mg every 4 weeks | CTC, BIO, RTX | 78% clinical improvement, 55% complete remission at 3 months | None | omalizumab achieves greater IgE reduction. Multiple comorbidities: Parkinson’s, dementia, DM, HF, hypothyroidism, IR | 4 |
“D’Aguanno K et al. (2022)” [24] | Systematic review of 22 articles | 56 | 300 mg every 4 weeks. One patient received a single dose of 450 mg | CTC | 87.5% respond to treatment at 13 weeks (55.4% complete remission, 32.1% partial) | None | NP | 2a |
“Seyed J et al. (2020)” [25] | Presentation of 1 case | 1, M 70 years | 300 mg every 4 weeks | CTC, DAP, MTX, MMF | Decrease in BP-100, EVA scale went from 9/10 to 2/10 after 2 months. Complete remission after 3 months | Persistent pruritus that was resolved by adding 600 mg dupilumab + 300 mg dupilumab | Complete remission with omalizumab + dupilumab after trying various treatments. Pcte with metabolic ds | 4 |
“Vassallo C et al. (2022)” [26] | Retrospective study of 222 patients | 222, 5 BP-dependent CTC patients with IC were selected for other treatments. Average age: 77.4 years. 3M, 2F | 300 mg every 4 weeks, treatment duration: average 9.2 months | CTC, IS, AH | Resolution of skin lesions in all patients and reduction of pruritus. Reduction of IgE and anti-BP180, BP230 and eosinophils | NE | Patients with several comorbidities: DM2, hepatitis, hip replacement, vitiligo, osteoporosis | 4 |
“Kremer N et al. (2019)” [11] | Systematic review of 35 publications | 84 PCs (62 receive RTX and 22 omalizumab) | NE | CTC | Complete remission 85% with RTX and 84% with omalizumab | 24% in treatment with RTX and 20% with omalizumab | Fewer recurrences with RTX than with omalizumab | 2a |
“Velin M et al. (2022)” [27] | Retrospective study | 112 (19 met inclusion criteria), mean age 76 years | 300 mg every 4 weeks SB, average of 9 months of treatment | CTC, MTX | 60% complete remission, 20% partial remission | One case with poor skin tolerance (burning sensation) for treatment with dupilumab (lasted 1 month with treatment) | Of the 19 patients, 12 received MTX, 7 omalizumab and 8 dupilumab | 4 |
“Kwon IJ et al. (2023)” [17] | Retrospective study | 49 (25 RTX only, 17 RTX + omalizumab) | 13 patients: 300 mg omalizumab twice (every 4 weeks) and 4 patients 300 mg omalizumab once | CTC, RTX | RTX + omalizumab improvement in 15 days vs. 67.5 days if only RTX. Control only RTX 92% vs. RTX + omalizumab 100% | None | 0% mortality RTX + omalizumab, 16% if RTX monotherapy | 4 |
“Yu KK et al. (2022)” [28] | Open, uncontrolled study | 6, F, average age 72.8 years | 300 mg every 2–4 weeks (6 cycles) | CTC, AZA, MC | Benefit in 5/6 patients with reduction in pruritus, eosinophils, blisters at 2 weeks | None | All failed previous treatment with CTC | 4 |
“Seyed J et al. (2019)” [29] | Presentation of 2 cases | 2, between 60–65 years | 300 mg every 2 weeks for 1 month | CTC, AZA, TC | After 1 month of treatment with AOM, blisters and itching disappear | None | NP | 4 |
“Alexandre M et al. (2022)” [30] | Retrospective study | 13, 5M, 8F, average age 66 years | 300 mg/450 mg/600 mg | CTC, MMF, DOX, MTX | Improvement in pruritus, hives, blisters, complete remission 85% at 3 months | 2 pneumonias, 1 kidney failure in very frail elderly patients (no clear correlation with omalizumab use) | 7/13 had mucosal involvement | 4 |
“James T et al. (2019)” [31] | Presentation of 1 case | 1, M 72 years | NE | CTC, IS, IVIg, RTX | Resolution of blisters, IgG decrease | NE | Multiple comorbidities: DM2, CKD grade IV | 4 |
“Ewy S et al. (2019)” [32] | Presentation of 1 case | 1, F 74 years | 300 mg every 4 weeks | NE | Reduction of pain and skin lesions | Injection site dermatitis that resolved spontaneously within 2 days | NP | 4 |
“Navarro-Triviño FJ et al. (2021)” [33] | Presentation of 1 case | 1M, 70 years | 300 mg subcutaneously every 3 weeks | CTC, AZA | Blisters disappear after 3 months | None | Analytical findings and refusal of patient to be treated with RTX due to PML risk | 4 |
“Balakirski G et al. (2016)” [34] | Presentation of 2 cases | 2, F 40 years old, M 63 years old | 1. 300 mg every 3 weeks 2. 300 mg every 3 weeks | 1. CTC, AZA 2. CTC | 1 and 2: Pruritus improvement after 5 days of treatment with omalizumab | None | 1. omalizumab was started at 300 mg every 4 weeks, but due to increased blisters, 300 mg was started every 3 weeks. 2. omalizumab was discontinued due to other health problems, reappearance of blisters, continued CTC | 4 |
“Garrido PM et al. (2020)” [13] | Presentation of 1 case | 1, F 76 years | 300 mg every 4 weeks | CTC, DOX, AZA, IVIg | Pruritus disappears after 3 days, complete resolution of skin lesions after 2 months | None | BP triggered by treatment with DDP-4 (vildagliptin) for DM treatment | 4 |
“From D et al. (2021)” [35] | Presentation of 6 cases | 6 (4F, 2M), average age 64.5 years | 300 mg every 4 weeks | NE, but CTC contraindicated due to comorbidities | NE | NE | Patients treated with AOM since due to their comorbidities they are IC other treatments | 4 |
“Gönül MZ et al. (2016)” [36] | Presentation of 1 case | 1, M 70 years | 300 mg every 4 weeks, total of 11 doses | CTC, TC, DAP | Disappearance of blisters, IgE decrease a week after treatment | Thrombocytopenia that did not require discontinuation of omalizumab | NP | 4 |
“Lonowski S et al. (2020)” [37] | Retrospective study | 11, average age 78 years | 10 treatments with 300 mg omalizumab every 4 weeks. One treatment with 375 mg every 2 weeks | CTC, RTX, AZA | 6/11 complete answer 3/11 partial answer 2/11 no response | 1 of them exacerbation of skin lesions that required discontinuation of omalizumab 1 of them had infection, died and had treatment with CTC 9/11 no adverse effects | The exacerbation of lesions with AOM was an AE that had not previously appeared and is the result of future research. | 4 |
“Menzinger S et al. (2018)” [38] | Presentation of a case | 1, F 76 years | 300 mg every 4 weeks | CTC | Disappearance of the disease after 8 weeks of treatment, itching improves after 2 days | None | Multiple comorbidities (CKD dementia, ischemic heart disease…) | 4 |
“Liu J et al. (2022)” [39] | Presentation of a case | 1, M 76 years | 300 mg every 4 weeks | AH, CTC | After 3 days itching improved, no new blisters appeared | NE | Multiple comorbidities that CI tto IS | 4 |
“Yalcin AD et al. (2014)” [40] | Presentation of a case | 1, M 28 years | 300 mg, 13 doses in total | CTC, CFF | Complete remission | NE | Young person (28 years old) | 4 |
“London VA et al. (2012)” [41] | Presentation of 1 case | 1, F 70 years | 300 mg every 4 weeks | CTC, AZA, MMF, CFF | Disappearance of blisters, decrease in anti BP180, disappearance of findings in IF | None | NP | 4 |
“Barrios DM et al. (2021)” [14] | Retrospective study | 34, 50% F mean age 67.5 a (9 of them due to BP) due to QT drug effects | NE | Combination with ipilimumab, atezolizumab, durvalumab | omalizumab improves pruritus and BP | 2/9 did not respond to omalizumab) | Treatment with AOM for complications QT treatment in solid tumors | 4 |
“Sinha S et al. (2020)” [42] | Presentation of a case | 1, F 44 years | 450 mg | CTC, RTX, AZA | Disappearance of blisters | NE | Obesity | 4 |
“Dufour C et al. (2012)” [43] | Presentation of 1 case | 1M 5 months | 100 mg, every 2 weeks for 3 months | CTC, AZA | Reduction of urticarial lesions and blisters. Complete resolution after 10 months of treatment | NE | BP in a 5-month-old baby | 4 |
“Fairley JA et al. (2009)” [44] | Presentation of a case | 1, F 70 years | 300 mg every 2 weeks | CTC, AZA, MC | Partial remission, decrease in eosinophils and anti BP180 | NE | NP | 4 |
“From A et al. (2021)” [45] | Presentation of 3 cases | 1 of them with BP, M 65 years old | 300 mg every 4 weeks | CTC, MMF | Complete remission after 3 months of treatment | NE | NP | 4 |
“Chebani R et al. (2024)” [46] | Retrospective study | 100, average age 77 years | 300 mg | NE | Complete remission 77% at 3 months | NE | More significant improvement if high levels of anti BP180 | 4 |
Appendix B
Study | Type of Study | Number of Patients | Dose Used | Previous Treatments | Results Obtained | Side Effects | Observations | Level of Evidence |
---|---|---|---|---|---|---|---|---|
“Cao P et al. (2022)” [23] | Systematic review 75 studies included | 211 in total, 36 treated with dupilumab, 53 with omalizumab and 122 with RTX | NE | CTC, MTX, MMF, AZA, CLP, CFF | Total remission 66.7% (24/36) Partial remission 19.4% (7/36) at 4.5 months | Recurrence 5.6% (2/36). No adverse effects | The rest of the patients included in the study (122) were treated with RTX, giving a higher number of recurrences, AEs and mortality | 2a |
“Russo R et al. (2022)” [47] | Literary review of 9 articles | 30 (16 M, 14 F), average age 69.85 years | NE | CTC, I.S. | Decrease in Th2 lymphocytes and improvement in pruritus | None, no interaction with other drugs | Some comorbidities: TB, melanoma, cancer, obesity, DM… | 2a |
“Zhao L et al. (2023)” [48] | Retrospective cohort study | 146, average age 73 years, 86% M | 300 mg every 2 weeks after an initial dose of 600 mg | NE | 127 (87%) BP control in 1 month | Injection site injuries did not require suspending dupilumab | 3 pctes pneumonia that improved with ATB without needing to suspend dupilumab (pneumonia associated with comorbidities) | 2b4 |
“Zhang Y et al. (2021)” [49] | Retrospective study | 24, average age 64.50 years (8 treatment with dupilumab + AZA + MTP and 16 AZA + MTP) | 600 mg initially, followed by 300 mg weekly | MTP, AZA | Complete remission 62.5%, partial remission 12.5% | Eosinophilia, recurrence 12.5% | Add dupilumab to MTP + AZA + effective than without dupilumab | 4 |
“Liang J et al. (2023)” [50] | Number of cases | 9, average age 68 years | NE | CTC | Total remission: 74.6% Partial remission 11.1% | NE | NP | 4 |
“Abdat R et al. (2020)” [12] | Case series from 5 academic centers | 13, average age 76.8 years | NE | NE | Total remission: 53.8%, response to treatment 92.3% | None | NP | 4 |
“Yan T et al. (2023)” [18] | Retrospective cohorts | 40 (20 treated with dupilumab and another 20 with dupilumab + CTC) | 600 mg initially followed by 300 mg weekly | CTC | Of the 20 treated only with dupilumab: 12 had complete remission, 8 had partial remission after 6 months of treatment. | NE | dupilumab improves AP symptoms, but fails to reduce BP180 levels | 2b |
“Oren-Shabtai M et al. (2023)” [22] | Series of 9 cases | 9, 1 of them treated with dupilumab, 3 with omalizumab and 7 with RTX average age 60.4 years | 600 mg initially, followed by 300 mg weekly | CTC, BIO, RTX | 78% clinical improvement, 55% complete remission | None | NP | 4 |
“Learned C et al. (2023)” [51] | Retrospective study | 17 (10 M and 7 F), average age 72.2 years | 300 mg weekly | MMF, DOX, CTC IVIg | 14 patients had complete remission, 2 had partial remission and 1 had significant improvement. | None | The patients included had tried 4 lines of treatment prior to dupilumab | 4 |
“Seyed J et al. (2020)” [25] | Description of a case | 1, M 70 years | 600 mg initially, followed by 300 mg weekly | CTC, DAP, MTX, MMF, omalizumab | Disappearance of pruritus, VAS scale 0/10, complete remission in AOM association | NE | Complete remission with omalizumab + dupilumab after trying various treatments. Pcte with metabolic ds | 4 |
“Velin M et al. (2022)” [27] | Retrospective study | 112 (19 met inclusion criteria) | 300 mg every 2 weeks | CTC, MTX | 60% complete remission, 20% partial remission | Only 1 percent in treatment with dupilumab skin burning sensation, only lasted 1 month with dupilumab | Of the 19 patients, 12 received MTX, 7 omalizumab and 8 dupilumab | 4 |
“Hu L et al. (2023)” [52] | Retrospective study | 11, average age 76 years, 4M, 7F | 600 mg followed by 300 mg every 2 weeks | I.S., M.C. | In 2 weeks 10/11 patients control the disease | None | NP | 4 |
“Qi W et al. (2023)” [53] | Compare 2 groups | 27 (9 received MTP + dupilumab), 18 only MTP, mean age 72 years | NE | MTP | Improvement of the disease in patients treated with MTP + dupilumab | None with dupilumab | NP | 4 |
“Klepper EM et al. (2021)” [54] | Case report | 1, F 79 years | 600 mg initially, followed by 300 mg weekly | CTC, DAP, DOX | After 1 month of treatment with dupilumab, 100% reduction in itching | NE | dupilumab indicated in people over 6 years of age | 4 |
“Yang J et al. (2022)” [55] | Retrospective cohort study | 40 (20 MTP only, 20 MTP + dupilumab) | 600 mg initially, followed by 300 mg weekly | MTP | Greater control of BP, pruritus and quality of life in MTP + dupilumab | Eosinophilia, thrombosis in 2 patients (1 from each group), PE, gastritis, pneumonia, herpes zoster | NP | 4 |
“Foerster Y et al. (2023)” [56] | Report of 3 patients, only 1 treatment with dupilumab | 3 patients with BP + HIV-1, patients treated with dupilumab M aged 60 years | 600 mg initially, then 300 mg every 2 weeks | CTC, AZA, DAP, DOX + antiretroviral treatment | Disappearance of itching and blisters | NE | Of the 3 exposed cases, only 1 was treated with dupilumab | 4 |
“Zhang X et al. (2023)” [57] | Retrospective study | 7 | 600 mg initially, followed by 300 mg weekly for 16 weeks | CTC, OMZ, tofacinib, CLP | 6/7 complete remission 1/7 partial improvement | None | NP | 4 |
“Sanfilippo E et al. (2023)” [58] | Report of 1 case | 1, M 80 years | NE | CTC | Improvement of itching and disappearance of blisters | NE | Background: AF, HF, T2DM, HTN, prostate cancer, stroke | 4 |
“Takamura S et al. (2022)” [59] | Presentation of 1 case | 1, F 72 years | NE | NE | Improves pruritus, blisters and anti-BP180 negativity | NE | NP | 4 |
“Wang Q et al. (2023)” [60] | Presentation of 1 case | 1, M 60 years | 600 mg initially, followed by 300 mg weekly | CTC, MTX | Improvement of itching in 3 days and blisters in 2 weeks, disappearance of Ig in 6 weeks | NE | Tto for 10 weeks after induction: CTC + dupilumab without AP recurrences | 4 |
“Wang SH et al. (2023)” [61] | Number of cases | 10 (7M, 3F) mean age 72.7 | Initially 600 mg, then 300 mg every 2 weeks | MTP, MC, AH, IVIg | 90% improvement in pruritus, complete remission 70%, average duration 8.3 weeks | Eosinophilia in 2 cases that was resolved with IS | Multiple comorbidities: DM, allergic rhinitis, osteoporosis, CMV infection, pneumocystis pneumonia | 4 |
“Wang M et al. (2022)” [62] | Presentation of 2 cases | 2 | 1. 300 mg dupilumab twice 2. 300 mg dupilumab twice | 1. MTP + MTX 2. MTP | 1. pruritus improvement in 2 weeks 2. lesion remission in 2 weeks | None | dupilumab prevents complications from other treatments such as RTX (infections and heart disease) | 4 |
“Bruni M et al. (2022)” [15] | Case study | 1, M 76 years | 300 mg dupilumab | MTP, DOX | Complete remission in 6 months | NE | BP triggered by nivolumab for treatment of lung metastases due to melanoma | 4 |
“Liu JH et al. (2023)” [63] | Case study | 1, M 73 years old | 600 mg subcutaneously, followed by 300 mg subcutaneously | DOX, CTC | Disappearance of PA lesions and psoriasis after 16 days of treatment with dupilumab. No relapses | NE | Effective treatment with dupilumab for psoriasis + BP | 4 |
“Manzo Margiotta F et al. (2023)” [64] | Presentation of a case | 1, M 74 years | 600 mg followed by 300 mg every 2 weeks | CTC, DOX, NT, DAP | Resolution of blisters and itching after 16 weeks of treatment | None | NP | 4 |
“Valenti M et al. (2022)” [65] | Case report | 1 | 600 mg followed by 300 mg every 2 weeks | MTP, AZA, DAP, CH | After 3 months anti BP230 normal levels | NE | NP | 4 |
“Savoldy MA et al. (2022)” [66] | Case study | 1, M 78 years old | 300 mg every 2 weeks | CTC, DOX, IS | Improvement after 6 weeks | None | AP triggered after COVID-19 vaccination | 4 |
“Zhou AE et al. (2022)” [67] | Presentation of a case | 1, F 17 years old | 300 mg | CTC, RTX, IVIg | Complete resolution after 4 weeks, improvement after 2 weeks of starting dupilumab | NE, no relapses | Young woman (17 years old) with BP, not AF | 4 |
“Pop SR et al. (2022)” [16] | Presentation of a case | 1, F 59 years | 300 mg dupilumab + CTC treatment | CTC, DOX, NT, DAP, MMF | Improvement of blisters | NE, CTC could be suspended without regrowth, leaving only dupilumab | BP induced by pembrolizumab for cervical cancer treatment. | 4 |
“Riqueleme- Mc Loughlin et al. (2021)” [68] | Presentation of a case | 1, F 37 years | 600 mg at 30 weeks, followed by 300 mg at 2 weeks | CTC | Itching and blisters improve, fetus birth without incidents | PROM at 34.4 weeks, birth by cesarean section | Case of gestational AP + frequent in 2nd and 3rd trimester | 4 |
“Zhang Y et al. (2021)” [69] | Presentation of a case | 1, F 61 years | 600 mg followed by 300 mg | CTC, AZA | Disappearance of itching after a month, no formation of new blisters | NE | NP | 4 |
“Kaye A et al. (2018)” [70] | Presentation of a case | 1, M 80 years | 600 mg followed by 300 mg | CTC | Full resolution at 3 m and normalization levels BP180 and BP230 | NE | TB infection and HBsAg + contraindicated immunosuppressive treatment | 4 |
“Jendoubi F et al. (2022)” [71] | Presentation of a case | 1, F 76 years | 600 mg followed by 300 mg every 2 weeks | CTC | Complete resolution of pruritus and blisters, without recurrence after 6 months | None | Pcte with nodular pemphigus (BP variant) | 4 |
“Fournier C et al. (2023)” [72] | Presentation of 3 cases | 1, M 74 years old | 600 mg followed by 300 mg | CTC | Complete remission | NE | Development of BP following treatment with nivolumab for melanoma | 4 |
“Huand D et al. (2023)” [19] | Retrospective cohort study | 36 patients, 20 receive MTP, 16 dupilumab +MTP, average age 71 years | 600 mg of dupilumab followed by 300 mg athenext week | NE | Pruritus decrease and BPDAI scale improvement + effective with MTP + dupilumab at 2 weeks | 2 cases dermatitis at injection site, 3 transient hyperglycemia, 4 hypereosinophilia | MTP + dupilumab group, MTP is suspended and 300 mg 2/wk dupilumab is continued as monotherapy. | 4 |
“Chen J et al. (2023)” [73] | Presentation of 2 cases | 2, M, 66 and 79 years | 600 mg initially, followed by 300 mg weekly for 16 weeks | NE | Clinical improvement without relapses | One of them had erythema at the injection site, which resolved itself. | Comorbidities: DM, asthma, HTN | 4 |
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Omalizumab | Dupilumab | |
---|---|---|
Number of patients treated | 363 | 523 |
Approved indications for the drug | Severe allergic asthma, chronic spontaneous urticaria, chronic risnosinusitis with nasal polyps | Asthma, nodular prurigo, atopic dermatitis, chronic rhinosinusitis with nasal polyposis, eosinophilic esophagitis, hand dermatitis |
Route of administration and dosage used in the studies | 300 mg/450 mg/600 mg subcutaneously every 2–4 weeks | 600 mg subcutaneously initially followed by 300 mg subcutaneously every 1–2 weeks |
Efficacy data of omalizumab and dupilumab to treat BP | Complete response: 76.13%, improvement in BP between 2 weeks and 6 months after starting treatment | Complete response: 70.39%, healing achieved between 2 weeks and 6 months after starting treatment |
Safety data | Less than 1% of patients presented adverse events, the most frequent were intense pruritus that resolved with dupilumab and dermatitis at the injection site that resolved spontaneously. | Less than 1% of patients presented adverse events, the most frequent were dermatitis at the injection site that resolved spontaneously and eosinophilia that resolved by adding IS. |
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Granados-Betancort, E.; Sánchez-Díaz, M.; Muñoz-Barba, D.; Arias-Santiago, S. Omalizumab and Dupilumab for the Treatment of Bullous Pemphigoid: A Systematic Review. J. Clin. Med. 2024, 13, 4844. https://doi.org/10.3390/jcm13164844
Granados-Betancort E, Sánchez-Díaz M, Muñoz-Barba D, Arias-Santiago S. Omalizumab and Dupilumab for the Treatment of Bullous Pemphigoid: A Systematic Review. Journal of Clinical Medicine. 2024; 13(16):4844. https://doi.org/10.3390/jcm13164844
Chicago/Turabian StyleGranados-Betancort, Elena, Manuel Sánchez-Díaz, Daniel Muñoz-Barba, and Salvador Arias-Santiago. 2024. "Omalizumab and Dupilumab for the Treatment of Bullous Pemphigoid: A Systematic Review" Journal of Clinical Medicine 13, no. 16: 4844. https://doi.org/10.3390/jcm13164844