Researchers reported that levels of anti-BP180 autoantibodies may be the best marker for monitoring the disease activity of bullous pemphigoid (BP). BP is an autoimmune skin disorder in which autoantibodies attack parts of the skin, specifically the BP180 and BP230 proteins. A recent study was published in JAMA Dermatology by Po-Yi Chou and colleagues. This study aimed to evaluate the relationship over time between the titers of anti-BP180 and anti-BP230 antibodies in patients with BP disease, concerning their severity.

The systematic review of studies searched databases from their inception up to and including April 11, 2024 for the Cochrane Central Register of Controlled Trials, Embase, and PubMed to identify studies that had measured the association of levels of anti-BP180 and anti-BP230 IgG antibodies with disease severity in BP. The Autoimmune Bullous Skin Disorder Intensity Score, or ABSIS, and the BP Disease Area Index, or BPDAI, assessed intralesional and lesional severity. About 0.4% of the studies retrieved were included in the final analysis.
Altogether, 14 studies were included in this metaanalysis with 1,226 patients. For data extraction and cross-validation, the services of two independent researchers were sought. In case of discrepancies, a third researcher resolved them. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used for assessment of bias. Random-effects model was utilized while conducting the meta-analysis. Subgroup analyses were conducted according to the manufacturers of ELISA kits that were used in different studies.
The meta-analysis of the studies had several important findings:
Anti-BP180 Correlation with Disease Severity:
• There was at baseline a moderate correlation between anti-BP180 antibody levels and BPDAI scores (r = 0.56, 95% CI: 0.46-0.64), and ABSIS scores (r = 0.52, 95% CI: 0.39-0.62).
• Correlation became stronger during the 3rd-month follow-up, with significant associations between anti-BP180 and BPDAI (r = 0.63, 95% CI: 0.39-0.79), and between anti-BP180 and ABSIS (r = 0.62, 95% CI: 0.39-0.79).
• At 6-month follow-up, moderate correlations were retained (BPDAI: r = 0.53, 95% CI: 0.25-0.72; ABSIS: r = 0.53, 95% CI: 0.25-0.72).
• Anti-BP230 Antibody Levels and Disease Severity: Anti-BP230 antibody levels did not correlate with disease severity at baseline or follow-up by either BPDAI or ABSIS, so the levels are of no utility for BP monitoring.
In conclusion, this systematic review and meta-analysis provides strong evidence for the use of anti-BP180 autoantibody levels as an adjunctive tool in the monitoring of BP disease severity. In this way, the good correlation with scores of BP at various time points suggests that these biomarkers may guide the treatment of the patient with BP.
Reference:
Chou, P.-Y., Yu, C.-L., Wen, C.-N., Tu, Y.-K., & Chi, C.-C. (2024). Bullous pemphigoid severity and levels of antibodies to BP180 and BP230: A systematic review and meta-analysis. JAMA Dermatology (Chicago, Ill.). https://doi.org/10.1001/jamadermatol.2024.3425