Dupilumab for Drug-Induced Bullous Pemphigoid: A Case Series and Literature Review

Abstract: Drug-induced bullous pemphigoid (BP) is an increasingly recognized variant of BP with unique challenges in management, particularly when patients require continuation of the offending medication or are contraindicated to conventional immunosuppressive therapies. We report 4 patients with drug-induced BP, three associated with dipeptidyl peptidase-4 inhibitors and one with immune checkpoint inhibitor, successfully treated with dupilumab. All four patients had failed or were intolerant to conventional therapies. Following dupilumab initiation, all patients experienced significant improvement in pruritus within 2 weeks. Complete remission was achieved in 3 patients within 1– 5 months of treatment and one patient had stable disease, enabling him to resume pembrolizumab therapy for esophageal cancer while on dupilumab. No significant adverse effects were reported during treatment periods. Our findings, supported by a literature review, suggest that dupilumab demonstrates promising efficacy and safety in treating drug-induced BP, with rapid improvement in pruritus and resolution of skin lesions. It may offer a valuable therapeutic alternative as a steroid sparing agent for elderly patients with multiple comorbidities and provides the potential to continue necessary medications (eg, cancer therapy) that may have triggered BP. Keywords: drug-induced bullous pemphigoid, dipeptidyl peptidase-4 inhibitors, immune checkpoint inhibitors, immunosuppressants, dupilumab, biologics