Late Breakers in Immunobullous Diseases

Matthew Vesely, MD delivered a focused update on the rapidly evolving treatment landscape for immunobullous diseases, emphasizing that bullous pemphigoid (BP) has firmly entered the targeted-therapy era. BP, driven by IgG and IgE autoantibodies against BP180 and BP230, is now treated with biologic agents that more precisely address type 2 inflammation. A major milestone is the FDA approval of dupilumab in June 2025, which blocks IL-4 and IL-13 signaling and achieved disease control in nearly 90% of patients within four weeks. Additional targeted options such as omalizumab, particularly effective in IgE-mediated disease, along with IL-13 inhibitors and JAK inhibitors, are expanding steroid-sparing strategies for BP management.

In contrast, pemphigus remains more challenging than anticipated. Rituximab continues to be the cornerstone of therapy, with long-term data confirming superior remission rates compared with corticosteroids alone. Encouraging studies of ultralow-dose rituximab suggest similar efficacy with potentially improved safety. However, the session also addressed recent setbacks, noting the failure of phase 3 trials for efgartigimod and rilzabrutinib, leading to discontinuation of development for pemphigus. Looking ahead, Dr Vesely highlighted emerging precision approaches, including deeper B-cell–directed therapies such as daratumumab and investigational cellular therapies, with the ultimate goal of biomarker-driven maintenance to prevent relapse. While not yet ready for routine practice, these advances signal continued progress toward more personalized care in immunobullous disease.