Are biologic agents of any help in treating mucous membrane pemphigoid?

Biologic treatments are effective in the treatment of mucous membrane pemphigoid (MMP), with a good safety profile, except for rituximab, a study has found. However, randomized clinical trials with long-term follow-up are warranted to confirm the safety and efficacy of these agents in MMP patients.

A team of researchers performed a systematic review of biologic treatment outcomes in patients with MMP. They searched the databases of Medline and Embase on 23 July 2020 and identified 63 studies using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Intravenous (IV) immunoglobulin (n=154), rituximab (n=112), tumour necrosis factor-α inhibitors (TNFi; n=7), and combination treatments (n=58) were used in 331 MMP patients.

Use of IV immunoglobulin resulted in complete resolution in 61.7 percent of patients within 26.0 months, with a recurrence rate of 22.7 percent). The most common adverse effect was headache (8.4 percent).

Treatment with rituximab also led to complete resolution in 70.5 percent of patients within 8.7 months, with a recurrence rate of 35.7 percent. Common adverse effects included urinary tract infections (4.5 percent), leukocytopaenia (2.7 percent), and death due to severe infections (1.8 percent).

Finally, TNFis completely resolved MMP in 71.4 percent of patients within 3.9 months of treatment. No adverse events were reported.

“MMP is an autoimmune disease that can lead to fibrosis of mucous membranes and functional impairment,” the researchers said. “Biologic agents should be explored as alternative treatment options to improve outcomes.”