Antibody Levels Tied to Bullous Pemphigoid Severity

TOPLINE:

Anti-BP180 antibody levels demonstrated a moderate to strong correlation with the severity of bullous pemphigoid (BP), in a meta-analysis highlighting the potential of anti-BP180 as a tool to monitor disease progression.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis to assess the potential correlation between the severity of BP and serum levels of autoantibodies (immunoglobulin G) against two antigens, BP180 and BP230.
• A total of 14 studies with 1226 participants with BP published up to April 2024 were included from the Cochrane Central Register of Controlled Trials, Embase, and PubMed databases.
• Disease severity was measured using the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) or Bullous Pemphigoid Disease Area Index (BPDAI).
• Studies reporting correlation coefficients (r) between antibody levels and clinical severity.

TAKEAWAY:

• Anti-BP180 levels showed a moderate correlation with BPDAI at baseline (r = 0.56), a strong correlation at 3-month follow-up (r = 0.63), and a moderate correlation at 6-month follow-up (r = 0.53).
• Anti-BP180 levels correlated strongly with the erosion or blisters subcomponent (r = 0.68) and correlated moderately with the urticaria/erythema/other subcomponent (r = 0.44).
• Similarly, anti-BP180 levels showed a moderate correlation with ABSIS at baseline (r = 0.52), a strong correlation at 3-month follow-up (r = 0.62), and a moderate correlation at 6-month follow-up (r = 0.53). A strong correlation with the skin subcomponent was reported (r = 0.60), but not with the oral mucosa or oral discomfort subcomponents.
• Anti-BP230 levels showed no significant association with BPDAI or ABSIS at baseline and follow-up.

IN PRACTICE:

“To our knowledge, this study is the first systematic review and meta-analysis to find a moderate to strong correlation of anti-BP180 autoantibody serum levels with BPDAI and ABSIS scores,” the authors wrote. Based on these findings, they added, “anti-BP180 autoantibody levels may serve as an adjunctive tool for monitoring BP disease severity and guiding clinical care for patients with BP.”

SOURCE:

The study was led by Po-Yi Chou, MD, MMS, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, and was published online on October 2, 2024, in JAMA Dermatology.

LIMITATIONS:

Only one study provided follow-up data on the correlation between autoantibody levels and the scores of BP severity. Statistical heterogeneity of the correlation of the anti-BP180 enzyme-linked immunosorbent assay with BPDAI was relatively high mainly because of varying correlation strength. Studies using self-developed severity scales were excluded from the analysis, and immunological subtypes of BP were not specifically studied.

DISCLOSURES:

The authors did not disclose any funding source or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.