Would you utilize rituximab or dupilumab for treatment resistant bullous pemphigoid?

Dupilumab is a phenomenal drug for BP in most patients and is inarguably safer. Updated to add that coverage is much easier with the new FDA approval! As an aside, tralokinumab has a better patient assistance program than dupilumab, and so far has worked just as well in my clinic as dupilumab. If a patient has significant mucous membrane disease, I might favor rituximab, but otherwise, I start with dupilumab.

Doxycycline +/- topical steroid handles most of my chronic BP. Dupilumab for the rest.

Yes, we will utilize prednisone as a bridging treatment and hopefully move patients then to dupilumab or rituximab.

I would use Rituximab simply based on one case experience where the patient flared two days after his first Dupilumab injection.