Table I.

Summary of bullous pemphigoid patients treated with OMZ

Patient no.	Patient age, sex, and disease duration	Problems and comorbidities	IgE levels at start of OMZ therapy, IU/mL	Eosinophil counts*	Regimen	Response	Final dose
1	70 y, Female, BP × 1 y	Steroid-refractory disease. Osteoporosis. Poor control on prednisone (40 mg daily), azathioprine (150 mg daily), minocycline 200 mg daily.	222	Elevated: 3.4 × 103/μL	300 mg SC q2 wk	1 wk After OMZ administration, significant decrease in itching, reduction of blister count by 44%. By 16 wk, BSA involvement decreased from 50% to 5%. Patient disease free for 15 wk after OMZ d/c and then flared. Repeated OMZ monotherapy led to clearance of disease. Remained symptom free for 5 mo. Flare was refractory to OMZ.	d/c’ed
2	78 y, Female, BP × 1.5 y	Steroid-refractory disease. Osteoporosis. Flared on prednisone taper, intense pruritus, niacinamide (2 g), doxycycline (200 mg).	1835	Not elevated: 1.8%, 0.12 × 103/μL	300 mg SC q6 wk, q8, q6, then q4 wk; maintenance dose of 300 mg every 4 wk for 20 mo	Successful taper off prednisone after 3 mo on OMZ. D/c’ed because of insurance. Relapse with new blister formation. OMZ restarted and titrated to effect. Patient has been symptom free for 20 mo on 300 mg q4 wk.	300 mg Q4 wk
3	72 y, Female, BP × 3.5 y	Multiple failed attempts at prednisone taper. Osteoporosis.	1181	Elevated: 19%, 5.4 × 103/μL	375 mg SC q4 wk	Successfully tapered off prednisone in 2 mo. Symptom free since.	375 mg Q4 wk
4	76 y, Female, BP × 6 mo	Steroid-refractory disease. Steroid psychosis. Failed intensive regimen of plasmapheresis, cyclophosphamide, and azathioprine.	287	Elevated: 31.9%, 1.64 × 103/μL	300 mg SC q4 wk	Cessation of pruritus and new blister formation within 24 h after OMZ administration. Symptom free on OMZ during taper and as monotherapy for a total of 42 mo.	300 mg Q4-Q8 wk
5	86 y, Female, long-standing BP	Steroid-refractory disease.	2135	Elevated: 1.81 × 103/μL	375 mg SC q2 wk	1 wk After OMZ administration, 22% reduction in blister count, d/c’ed because of intercurrent exacerbation of COPD 2/2 to discontinuation of prednisone. No adverse effects caused by OMZ.	N/A
6	55 y, Female, BP × 7 mo	Failed prednisone taper, followed by steroid-refractory disease.	5821	Elevated: 17.7 × 103/μL	375 mg SC q2 wk	1 wk After OMZ administration, cessation of new blister formation, 30% reduction in BSA involvement, all clear after 3 wk; taper begun after 3 doses of OMZ; disease free for 3 mo, OMZ d/c’ed because of insurance, relapsed. Resumed prednisone, azathioprine, and minocycline.	N/A

The asthma dosing nomogram was used to obtain the starting dose and dosing interval for patients 1, 5, and 6. It was used for the initial dose of OMZ for patients 2, 3, and 4. The subsequent doses in these patients were titrated to effect and/or availability of the medication. In patients 2, 3, 5, and 6, the initial IgE levels exceeded the maximum asthma nomogram values (600–700 IU/mL), and the maximum recommended dose appropriate for the patients’ weight was used.

BP, Bullous pemphigoid; BSA, body surface area; COPD, chronic obstructive pulmonary disease; d/c, discontinue; N/A, not applicable; OMZ, omalizumab; Q, every; SC, subcutaneous injection.

^*In patients 1, 5, and 6, only the absolute eosinophil counts were available. In patients 2, 3, and 4, both the relative and absolute eosinophil counts were reported. Reference ranges: <7% and <0.18 × 10³/μL, respectively.