The Role of Anti-BP180 Antibody Monitoring in Bullous Pemphigoid: An Italian Single-Center Experience

Introduction: Bullous pemphigoid (BP) is the most common autoimmune blistering disorder, with anti-BP180 antibodies playing a key role in its pathogenesis and diagnosis. However, their utility in disease monitoring remains debated. Objectives: This study evaluate the role of anti-BP180 antibody monitoring in BP management through a single-center retrospective analysis and literature review. Methods: We analyzed 149 BP patients diagnosed between 2014 and 2024 at the Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna. Anti-BP180 titers were measured at baseline, six months, and remission. Therapeutic responses and antibody dynamics were assessed and compared with the literature. Results: Higher baseline anti-BP180 levels correlated with severe disease and prolonged remission times. A ≥60% reduction in titers was associated with successful therapeutic tapering and lower relapse rates. Patients with secondary BP forms exhibited lower baseline titers and faster remission. Conclusions: Anti-BP180 monitoring serves as a valuable adjunct to clinical assessment, aiding therapeutic decisions, particularly in determining tapering timelines. Nonetheless, integrated approaches combining serological and clinical evaluations remain essential.