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International Journal of Clinical and Experimental Medicine Research

ISSN Online: 2575-7970 ISSN Print: 2575-7989 CODEN: IJCEMH
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ArticleOpen Access http://dx.doi.org/10.26855/ijcemr.2025.05.005

A Case of Bullous Pemphigoid Treated with Stapokibart Injection

Xueying Zhang, Yi Sun*

Jingzhou Hospital Affiliated to Yangtze University, Jingzhou 434000, Hubei, China.

*Corresponding author: Yi Sun

Published: May 31,2025

Abstract

This case report presents a comprehensive evaluation of a 59-year-old male patient with refractory bullous pemphigoid (BP) complicated by severe nail dystrophy, demonstrating the remarkable therapeutic efficacy of Stapokibart, a novel IL-4Rα monoclonal antibody. The patient presented with a six-month history of intractable generalized pruritus (VAS score 8/10) that progressed to painful, tense bullae on the hands and feet, accompanied by characteristic nail abnormalities including subungual hyperkeratosis (2.3mm thickness), longitudinal ridging, and yellow-green discoloration, indicating significant nail unit involvement. Diagnostic confirmation was established through: (1) Histopathological examination revealing subepidermal blistering with dense eosinophilic infiltration (45-50 cells/HPF); (2) Direct immunofluorescence demonstrating linear IgG (3+) and C3 (2+) deposition at the dermoepidermal junction; (3) Elevated serum autoantibody levels (anti-BP180: 149.67 U/mL; anti-BP230: 113.60 U/mL). Following inadequate response to conventional therapy (methylprednisolone 20mg/day + topical clobetasol for 4 weeks with <30% improvement), the patient was treated with Stapokibart (600mg loading dose followed by 300mg subcutaneously every two weeks) in combination with low-dose methylprednisolone (8mg/day). Therapeutic outcomes were particularly noteworthy: (1) By week 2: Significant pruritus relief (VAS score reduced to 3/10) and 60% clearance of bullous lesions; (2) By week 4: Complete resolution of pruritus and 90% healing of skin lesions; (3) By week 8: Full cutaneous remission with normalization of nail plate thickness (reduced to 1.1mm); (4) Serological correlation: 92% reduction in anti-BP180 antibody titers and normalization of eosinophil count (0.35×10⁹/L). Mechanistic studies revealed: (1) Rapid suppression of Th2 inflammatory pathway: 78% reduction in IL-5 and 83% reduction in IL-31 by week 4; (2) Immune modulation: 2.1-fold expansion of regulatory T cells (confirmed by flow cytometry); (3) Structural protection: Electron microscopy confirmed restoration of hemidesmosome integrity. This case provides compelling evidence for Stapokibart's dual therapeutic ad-vantages in BP management: (1) superior efficacy in treatment-resistant cases (BPDAI score improved from 32 to 2), and (2) unique ability to reverse nail dystrophy—a clinical manifestation previously considered refractory to treatment. The successful 80% reduction in steroid dosage without disease recurrence highlights its significant steroid-sparing potential. These findings establish Stapokibart as a groundbreaking therapeutic option that addresses critical unmet needs in BP treatment. Further controlled clinical trials are warranted to fully evaluate its long-term efficacy, safety profile, and cost-effectiveness.

Keywords

Stapokibart; Bullous pemphigoid; IL-4Rα inhibitor; Nail dystrophy; Autoimmune blistering disorder

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How to cite this paper

A Case of Bullous Pemphigoid Treated with Stapokibart Injection

How to cite this paper:  Xueying Zhang, Yi Sun. (2025) A Case of Bullous Pemphigoid Treated with Stapokibart Injection. International Journal of Clinical and Experimental Medicine Research, 9(3), 276-283.

DOI: http://dx.doi.org/10.26855/ijcemr.2025.05.005

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