A systematic review of the role of interleukin-17 inhibitors in bullous pemphigoid: therapeutic and paradoxical effects.

Bullous pemphigoid (BP) is the most common autoimmune-driven blistering disease. The incidence of BP has been rising due to population aging and exposure to medications such as biologics. Moreover, biologics are utilized as therapeutic choices for BP treatment as they inhibit cytokines and disrupt pathogenesis pathways. Secukinumab and ixekizumab are two biologics that block interleukin (IL)-17A cytokines, a crucial factor in the autoimmune inflammatory pathway. We aim to systematically evaluate the effect of IL-17 inhibitors on treating and triggering BP disease. A systematic search was carried out up to Sept 16, 2023, in PubMed/Medline, Ovid-Embase, Scopus, and Web of Science. Clinical studies published in English were included. The search identified 282 relevant records, and ten articles were included. Moreover, one clinical trial was found through a search on Clinicaltrial.gov. Secukinumab and ixekizumab significantly improve BP lesions and blisters in combination with prednisolone or alone in BP subjects with or without concomitant psoriasis. However, ixekizumab has failed in a recent clinical trial. In contrast, BP has developed in some patients who were treated with these drugs for an underlying condition. IL-17 inhibitors exert both beneficial and paradoxical effects on BP. Further investigations are warranted to better understand the effects of these agents on BP.