Biomarkers of treatment efficacy in patients with chronic spontaneous urticaria

Sánchez-Borges, Mario; Capriles‐Hulett, Arnaldo; Caballero‐Fonseca, Fernan; González-Aveledo, Luis

doi:10.23822/eurannaci.1764-1489.24

Cited by 25 publications

(24 citation statements)

References 27 publications

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“…Some of these autoantibodies, such as IgE anti-IL-24 antibodies, are possible biomarkers, and their levels correlate with disease severity. 5 , 38 , 39 , 40 On the other hand, low total IgE level prior to initiation of therapy was associated with a slower response to omalizumab, reduced efficacy of this drug and a shorter time to disease relapse after omalizumab discontinuation. 41 , 42 , 43 Similarly, we have found in our cohort, that lower baseline IgE correlated with r-CSU, further supporting baseline IgE levels as a marker of response to anti-IgE therapy.…”

Section: Discussionmentioning

confidence: 99%

Combination therapy with omalizumab and an immune-suppressive agent for resistant chronic spontaneous urticaria - A real-life experience

Maoz-Segal

Levy

Yahia

et al. 2020

World Allergy Organization Journal

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Background Chronic Spontaneous Urticaria (CSU) is a relatively common immune mediated disease that can be effectively treated nowadays. Nevertheless, for some patients remission cannot be achieved following current treatment recommendations, defined as resistant CSU (r-CSU). Treating r-CSU is challenging, and, currently, there are no recommended interventions. In this real-life study we describe successful therapy of 18 r-CSU patients using an "intensified protocol" of anti-IgE-antibody (omalizumab) concomitantly with an immunosuppressant. We defined the r-CSU phenotype and compared it to omalizumab-responsive CSU (Or-CSU) phenotype. Methods Clinical and serological data of 72 CSU patients (ie, 18 r-CSU and 54 age and sex matched Or-CSU) were retrospectively collected and analyzed. All patients were diagnosed with CSU for ≥6 months and treated at the Sheba Medical Center during 2013–2018. Results Of 289 CSU patients, 18 (6%) were diagnosed with r-CSU and treated with the "intensified protocol" including omalizumab and cyclosporine-A (16p), methotrexate (1p), and azathioprine (1p). Of which, 14/18 (78%) achieved complete remission, 2/18 (11%) partial remission, and 2/18 (11%) no remission. During follow-up no serious adverse events were documented. r-CSU patients received higher doses of antihistamine (p < 0.0001) and omalizumab (425 ± 58 mg/month vs. 283 ± 86 mg/month; p < 0.0001) compared to Or-CSU. The r-CSU phenotype was linked with concomitant autoimmunity (p = 0.0005) and a lower level of IgE prior to initiation of therapy (p = 0.027). Conclusion r-CSU may be a distinct CSU phenotype characterized by severe disease, concomitant autoimmunity, and lower baseline-IgE levels (low "autoallergy"). An "intensified protocol" with omalizumab and an immunosuppressive agent was found to be efficacious and safe for r-CSU. Further larger studies are required to verify these results.

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Section: Discussionmentioning

confidence: 99%

Combination therapy with omalizumab and an immune-suppressive agent for resistant chronic spontaneous urticaria - A real-life experience

Maoz-Segal

Levy

Yahia

et al. 2020

World Allergy Organization Journal

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“…Previous studies (mostly with a retrospective design and small samples) have evaluated anti-TPO IgE as a possible prognostic biomarker of the duration and severity of CSU. However, evidence is inconsistent or weak [5, 13, 14]. It seems that these antibodies can help to identify 2 clinical phenotypes of patients with CSU: a phenotype associated with conditions linked to the Th2 response and reactions to NSAIDs, and a phenotype associated with the presence of inducible urticaria.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characterization of Patients with Chronic Spontaneous Urticaria according to Anti-TPO IgE Levels

Sánchez

2019

Journal of Immunology Research

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Background Chronic spontaneous urticaria (CSU) is a heterogeneous disease with some frequent comorbidities like autoimmune diseases, drug reactions, and inducible urticaria. IgE antibodies against thyroid peroxidase (anti-TPO IgE) could be associated with some of these clinical characteristics. Objective To explore the clinical characteristics of CSU patients, according to the presence of anti-TPO IgE in serum. Methods Anti-TPO IgE levels were measured during the clinical control period (Urticaria Activity Score, 0 point) and exacerbation period (≥3 points) in 100 CSU patients. Patients with self-reported exacerbation of skin involvement by foods, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical triggers underwent controlled challenge tests. Results We identified 2 groups of patients: (1) patients with anti-TPO IgE during the clinical control period or during an exacerbation, who had a higher frequency of atopy, asthma, and positive challenge test results with NSAIDs and (2) patients without anti-TPO IgE during any period, who had a higher frequency of positive challenge test results for inducible urticaria. Among the first group (anti-TPO IgE at any point), we identified 3 subgroups: patients with anti-TPO IgE during the clinical control period (n = 12); patients with anti-TPO IgE during the clinical control period and significantly increased levels during an urticaria exacerbation (n = 18); and patients with anti-TPO IgE only during an exacerbation (n = 13). None of the patients with self-reported food reactions had a positive challenge test result. Conclusion Anti-TPO IgE is a useful biomarker for differentiating between clinical phenotypes of patients with CSU. Elevation of anti-TPO IgE during exacerbation periods supports an association between this autoantibody and the pathogenesis of urticaria.

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“…In the reduced number of our patients who underwent to D-dimer determination, more than half presented elevated levels, and those were associated to a higher frequency of concomitant angioedema and lack of control with antihistamines. Besides D-dimer, IL-6 and Lipocalin 2 have been described as serum markers that potentially predict therapeutic response 23 …”

Section: Discussionmentioning

confidence: 99%

Latin American chronic urticaria registry (CUR) contribution to the understanding and knowledge of the disease in the region

Gómez

Járes

Borges

et al. 2019

World Allergy Organization Journal

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Chronic urticaria (CU) has a widespread spectrum on causal or exacerbating factors, clinical manifestations, therapeutic response and quality of life affectation. Registries are useful tools in several real-life diagnosis and management approach. We aimed to evaluate the characteristics of CU patients living in Latin America through an original cross-sectional registry with data entered by regional allergologists. Results Three hundred patients were included, being 72% female, with median age of 36 years (1–85) and 20 months of CU median evolution time. The cause of CU was reported as unknown in 72% of them. Thirty-nine percent of suspected cases presented positive serology for Mycoplasma, positive autologous serum skin test (ASST) was reported in 47%, and occasional presence of thyroid or antinuclear autoantibodies and parasites. The impact of pruritus in their quality of life was moderate to severe in 60% of patients, with almost 3 out of four patients having partial or lack of urticaria control with anti-histamines. Conclusions Our registry provides retrospective data on the real-life assistance of a large number of patients from the region. Continuous search for associated conditions and better treatment possibilities are needed, in order to control the significant impact on quality of life and the length of disease.

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Biomarkers of treatment efficacy in patients with chronic spontaneous urticaria

Cited by 25 publications

References 27 publications

Combination therapy with omalizumab and an immune-suppressive agent for resistant chronic spontaneous urticaria - A real-life experience

Combination therapy with omalizumab and an immune-suppressive agent for resistant chronic spontaneous urticaria - A real-life experience

Clinical Characterization of Patients with Chronic Spontaneous Urticaria according to Anti-TPO IgE Levels

Latin American chronic urticaria registry (CUR) contribution to the understanding and knowledge of the disease in the region

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