Cyclosporine and omalizumab together: A new option for chronic refractory urticaria

Sánchez, Jorge; Álvarez, Leidy

doi:10.1016/j.jaip.2020.02.012

Cited by 21 publications

(11 citation statements)

References 7 publications

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“…Few studies have examined the clinical outcomes using cyclosporine alone in omalizumab-refractory chronic urticaria. Both Rosenblum et al [ 8 ] and Sanchez et al [ 9 ] reported that concomitant omalizumab and cyclosporine was safe and efficacious in adult patients with CSU refractory to individual immunomodulators. This case series, in contrast, describes five omalizumab-refractory patients who were switched to cyclosporine without concomitant omalizumab.…”

Section: Discussionmentioning

confidence: 99%

Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases

LaCava,

Fadugba

2023

Allergy Asthma Clin Immunol

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Background While both the AAAAI/ACAAI and the EAACI/GA2LEN/EuroGuiDerm/APAAACI guidelines recommend starting cyclosporine for patients with chronic urticaria who have had an inadequate response to omalizumab, many clinicians are hesitant to initiate cyclosporine due to paucity of clinical data. The objective of this study was to report real-life clinical outcomes in adult patients with chronic urticaria who had an inadequate response to omalizumab and were switched from omalizumab to cyclosporine. Medical records of adult patients with chronic urticaria who had an inadequate response with omalizumab and were later treated with cyclosporine were reviewed retrospectively. Data pertaining to treatment method, clinical response, and adverse effects were recorded. Results/presentation of cases Five patients with omalizumab-refractory chronic urticaria, three of whom also had angioedema and one with an inducible urticaria, were treated with low doses of oral cyclosporine (1–3 mg/kg/d). Four of five patients in this case series had complete resolution of symptoms with oral cyclosporine, while continuing other standard therapies. Systemic side effects occurred in three patients which prompted drug discontinuation in two patients. Discussion Cyclosporine alone was effective in inducing urticaria control in adult patients with chronic urticaria who had an inadequate response to omalizumab, though the impact of cyclosporine was limited by reversible adverse effects. Adverse effects were associated with pre-existing medical conditions. As novel chronic urticaria therapies are being investigated, this experience highlights the importance of uncovering chronic urticaria subtypes which tend to respond to cyclosporine, while providing alternative treatments with better tolerability.

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Section: Discussionmentioning

confidence: 99%

Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases

LaCava,

Fadugba

2023

Allergy Asthma Clin Immunol

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“…There also reports that shortening the injection interval can lead to complete response inpatients with partial or no response to omalizumab 300 mg every 4 weeks. The most recent guidelines recommend cyclosporine add-on as a fourth-line treatment in CSU patients whose urticaria is not controlled with omalizumab treatment [3,4,37].…”

Section: Predictors Of the Response To Omalizumab Treatmentmentioning

confidence: 99%

The Use of Omalizumab in Chronic Urticaria: Available Data and Future Aspects of Anti-IgE Treatment

Ye¹

2021

Urticaria - Diagnosis and Management

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Chronic urticaria (CU) defined as repeatedly occurred itchy wheals and/or angioedema for at least 6 weeks. Due to the unpredictability, recurrent and disabling symptoms, and a considerably impaired quality of life, effective and tolerable treatment for CU patients is crucial. Almost a half of patients with CU are refractory to H1-antihistamines, even though the dose of antihistamines is increased up to 4-fold. Recently treatment modulating IgE levels and activities provides an efficient therapeutic approach. Omalizumab, the only approved anti-IgE treatment for chronic spontaneous urticaria (CSU) patients until now, with a strong evidence of the efficacy and safety, opened a new horizon in the care of the patients whose urticaria is not controlled with antihistamines. Recent international guidelines recommend omalizumab as the first choice of treatment for antihistamine-refractory CSU. However, as it is not curative neither disease-modifying agent, there is a subpopulation of CSU patients responding partly or never to omalizumab. The other things to be solved in the treatment of CU is that clinical evidence is still limited on chronic inducible urticaria (CIndU) and special populations. Thus, a new anti-IgE treatment, ligelizumab is actively evaluated in the efficacy compared with both placebo and omalizumab. Further understandings on the pathogenesis of CU can lead to the development of new mechanism-based therapeutics for CU patients.

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“…[6][7][8] 10-30% of patients do not achieve a satisfactory control of the disease and recurrence is possible. 9 Epidemiology shows the weight of sex's matter in CSU but sex-or gender-stratified analysis for treatment efficacy is missing. Unfortunately, in clinical practice, the sex and gender differences are still neglected in the era of precision medicine.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in the efficacy of omalizumab in the treatment of chronic spontaneous urticaria

Sirufo

Bassino

Pietro

et al. 2021

Int J Immunopathol Pharmacol

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Background Omalizumab is shown to be effective in the treatment of chronic spontaneous urticaria (CSU), a disease with high personal and social impact. Sex differences in CSU are recognized with women more frequently affected. Scarce is the knowledge about response to omalizumab between sex groups. We sought to identify any differences based on the sex of patients receiving omalizumab. Methods We evaluated data of patients diagnosed with CSU refractory to high-dose second-generation H1 antihistamines and treated with 300 mg omalizumab every 4 weeks for 6 months and then at relapse. Results Discussion: All patients, regardless of sex, age, or any other factor, achieved the clinical remission of the disease after the first 3 doses with a reduction of the disease activity indices and impact on the quality of life. Recurrences predominate in men, two months after the suspension of the drug. Respect to sex and recurrence we did not find any correlation with age, body mass index, peripheral eosinophil counts, total IgE levels, D-dimer, plasma prothrombine level or C-reactive protein. We found no sex differences in tolerability and safety. CSU in girls may persist longer and have worse prognosis, but no one has so far noted sex differences in response to omalizumab. Conclusions Although there are no certainties on the mechanism of action of omalizumab in CSU, the noticeable difference in response between males and females lead us to suppose a role of the hormonal balance both on the pathogenesis of the CSU and on the efficacy of OmAb.

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Cyclosporine and omalizumab together: A new option for chronic refractory urticaria

Cited by 21 publications

References 7 publications

Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases

Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases

The Use of Omalizumab in Chronic Urticaria: Available Data and Future Aspects of Anti-IgE Treatment

Sex differences in the efficacy of omalizumab in the treatment of chronic spontaneous urticaria

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