Dupilumab as a Therapeutic Option in Autoimmune Bullous Diseases Following SARS-CoV-2 Infection and COVID-19 Vaccination: A Comprehensive Case Series Analysis

The global vaccination campaign against SARS-CoV-2, started in December 2021, is the primary defense against COVID-19. Since then, the scientific community has been actively investigating the potential increase in autoimmune and autoinflammatory conditions linked to both the infection and vaccination, particularly with recombinant-mRNA Comirnaty (BNT162b2) and Spikevax vaccines. Within this context, increasing reports of autoimmune bullous diseases (AIBD) have been published in the literature. We present the cases of 4 patients diagnosed with AIBD, two males and two females aged between 19 and 82 years that presented generalized bullous eruptions following COVID-19 disease and vaccination. All patients underwent the same diagnostic and therapeutic protocol in agreement with the current international guidelines. Dupilumab, an anti-IL 4/13 biologic drug approved for moderate to severe atopic dermatitis, was chosen as long-term corticosteroid-sparing immunomodulating therapy. Dupilumab was administered at 600 mg loading dose followed by 300 mg biweekly. Three patients achieved complete remission and stopped corticosteroids, maintaining disease long-term control. The fourth, with pemphigus vulgaris, was unresponsive and subsequently received rituximab. The aim of our study was to recognize the features of SARS-CoV-2 and COVID-19 vaccination–related AIBDs. Additionally, we evaluated the response and tolerability to dupilumab, as an alternative adjunctive treatment to traditional systemic immunosuppressants and suggested potential diagnostic and clinical markers of response to dupilumab therapy in AIBDs.