Real-World Outcomes of Stapokibart-Based Combination Therapy for Bullous Pemphigoid: A Single-Center Retrospective Cohort

INTRODUCTION: Bullous pemphigoid (BP) affects older adults and treatment is often limited by corticosteroid toxicity. Evidence for stapokibart in BP is limited. OBJECTIVE: To describe the clinical outcomes and safety of stapokibart-based combination therapy in BP. METHODS: We retrospectively reviewed consecutive BP patients who received stapokibart-based combination therapy at Peking Union Medical College Hospital between October 2024 and October 2025, and had a follow-up period of at least four months. Stapokibart was administered as 600 mg loading dose, followed by 300 mg every two weeks. Outcomes included time to disease control, time to Bullous Pemphigoid Disease Area Index (BPDAI) activity score of 0, complete remission (CR) on minimal therapy, adverse events, and changes in BPDAI activity, pruritus numeric rating scale (NRS), anti-BP180 titers, eosinophil counts, and concomitant corticosteroid exposure throughout the follow-up period. RESULTS: Twelve patients were enrolled, with a median age of 77.5 years and a median follow-up period of 216.5 days. All received concomitant Tripterygium glycoside, and 7/12 (58.3%) also received oral corticosteroids at stapokibart initiation. All patients achieved disease control, with a median time of 14.5 days. Eleven out of 12 patients (91.7%) reached disease control within four weeks. BPDAI activity score of 0 was reached in all patients (median 65.5 days). Seven patients (58.3%) achieved CR on minimal therapy (median 176.0 days among responders). During follow-up, BPDAI activity, pruritus NRS, eosinophil counts, anti-BP180 titers, and prednisone dosages all decreased. One patient reported temporary fatigue and later developed herpes zoster. No patients stopped treatment throughout the study. CONCLUSION: Stapokibart-based combination therapy was associated with rapid short-term disease control and clinical improvement in this small retrospective BP cohort. Given the limited sample size and frequent concomitant therapy, these preliminary findings require confirmation in larger controlled studies.