Efficacy and safety of omalizumab therapy in urticaria vasculitis

Petrelli, Fiorella; Giannini, Daiana; Bilia, Silvia; Corso, Isabella Del; Migliorini, Paola; Puxeddu, Ilaria

doi:10.3389/falgy.2022.952079

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…3 While anti-IgE medications such as omalizumab can be used to treat these patients, they are expensive, and some patients do not respond well to them. 3 Urticarial vasculitis (UV) is a rare immune complex mediated smallvessel leukocytoclastic vasculitis, characterized by long-lasting urticarial lesions, persisting more than 24 h. 4 Corticosteroides, or immunosuppressive therapies such as azathioprine, cyclophosphamide, or cyclosporines are among the most effective drugs used for disease control. However, side effects, especially in the case of prolonged administration, and/or lack of efficacy often require discontinuation of the treatment.…”

Section: Introductionmentioning

confidence: 99%

“…However, side effects, especially in the case of prolonged administration, and/or lack of efficacy often require discontinuation of the treatment. 4 Therefore, the therapeutic approaches to these two diseases are currently challenging and it is necessary to find new and safe therapeutic targets to improve disease control.…”

Section: Introductionmentioning

confidence: 99%

“…Corticosteroides, or immunosuppressive therapies such as azathioprine, cyclophosphamide, or cyclosporines are among the most effective drugs used for disease control. However, side effects, especially in the case of prolonged administration, and/or lack of efficacy often require discontinuation of the treatment 4 …”

Section: Introductionmentioning

confidence: 99%

“…Urticarial vasculitis (UV) is a rare immune complex mediated small‐vessel leukocytoclastic vasculitis, characterized by long‐lasting urticarial lesions, persisting more than 24 h 4 . Corticosteroides, or immunosuppressive therapies such as azathioprine, cyclophosphamide, or cyclosporines are among the most effective drugs used for disease control.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of oral tofacitinib in refractory chronic spontaneous urticaria and urticarial vasculitis

Mansouri

Mozafari

Chalangari

et al. 2022

Dermatologic Therapy

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The treatment of chronic urticaria (CU) is difficult, currently, antihistamines (AH) are the mainstay of treatment, however, up to 40% of patients do not respond to even high (four‐fold) daily doses of AH. Tofacitinib is, a small‐molecule that blocks JAK1/3 and inhibits intracellular signaling of multiple key cytokines involved in the inflammatory cascade and its beneficial effects were reported in patients with mast cell activation disease but there is no report in patients with urticaria. Here, we present four cases of refractory CU and one case of urticarial vasculitis (UV) that were managed with tofacitinib. Despite the long‐term unresponsiveness of various treatments in our patients, the addition of tofacitinib significantly improved the urticarial activity and ultimately led to tapering and discontinuation of cyclosporine or AH. In conclusion, tofacitinib appears to downregulate inflammatory phenomena associated with mast cells and might be a new therapeutic option for patients with refractory CU or UV.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of oral tofacitinib in refractory chronic spontaneous urticaria and urticarial vasculitis

Mansouri

Mozafari

Chalangari

et al. 2022

Dermatologic Therapy

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Urticarial vasculitis

Ergun

2024

Current Opinion in Rheumatology

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Purpose of review Urticarial vasculitis is a rare condition manifesting with a variety of clinical presentations ranging from skin limited lesions to life-threatening systemic illnesses. This review aims to highlight the recent findings on the etiology, diagnostic modalities, and therapeutic strategies and course of urticarial vasculitis. Recent findings In addition to well established triggers, urticarial vasculitis (UV) cases associated with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) disease and COVID-19 vaccines, vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome, and adenosine deaminase (ADA) deficiency have been reported. A clinical-dermoscopic model for differentiating urticarial vasculitis has been developed with purpuric patches and globules favoring UV diagnosis and thus diminishing the need for histopathology. The efficacy of treatment modalities has been reviewed, and antihistamines, systemic corticosteroids, omalizumab, cyclophosphamide, tocilizumab, anti-interleukin (IL)-1 agents, and rituximab were shown to have the highest success rates. Regarding the durability of remission, rituximab, dapsone, and MMF were related to long-lasting treatment free responses. The course of hypocomplementemic urticarial vasculitis was investigated in an epidemiological study, revealing 5- and 10-year survival rates of 92% and 83%, respectively. Chronic obstructive pulmonary disease, septicemia, and end-stage renal disease were identified as causes of mortality. Summary With the aid of dermoscopy, a noninvasive tool, differentiation from chronic spontaneous urticaria can be made, and the need for histopathological examination can be diminished. Although clear definitions and consensus criteria for performing disease severity are lacking, careful screening is needed to tailor the treatment on an individual basis. Emerging infections like SARS-CoV 2, vaccines, and autoinflammatory disorders like VEXAS syndrome and ADA deficiency are new associations. The optimal use of well established agents like systemic corticosteroids and immunomodulators are mainstay treatment modalities, whereas IL-1 inhibitors, omalizumab, rituximab and Janus Kinase inhibitors may represent viable alternatives in selected cases.

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