Biologic Treatment Outcomes in Mucous Membrane Pemphigoid: A Systematic Review
Journal of the American Academy of Dermatology. 2021
BACKGROUND Mucous membrane pemphigoid (MMP) is an autoimmune disease, which can lead to fibrosis of mucous membranes and functional impairment. Biologic agents should be explored as alternative treatment options to improve outcomes. OBJECTIVE To conduct a systematic review of biologic treatment outcomes in patients with MMP. METHODS MEDLINE and EMBASE search was conducted on July 23(rd), 2020 to include 63 studies using PRISMA guidelines. RESULTS Use of IVIG (n=154), rituximab (n=112), TNFα inhibitors (n=7), and combination treatments (n=58) were reported in 331 patients with MMP. IVIG led to complete resolution in 61.7% (n=95/154) of patients within 26.0 months, with a recurrence rate of 22.7% (n=35/154) and headache as the most common side effect (8.4%, n=13/154). Rituximab led to complete resolution in 70.5% (n=79/112) of patients within 8.7 months, with a recurrence rate of 35.7% (n=40/112). Most commonly reported side effects were urinary tract infections (4.5%, n=5/112), leukocytopenia (2.7%, n=3/112), death due to severe infections (1.8%, n=2/112). TNFα inhibitors led to complete resolution in 71.4% (n=5/7) of patients within 3.9 months of treatment, without reported adverse events. CONCLUSIONS Randomized clinical trials with long term follow up are required to conclude the promising safety and efficacy of biologic agents in MMP patients.