Rituximab in Refractory Chronic Spontaneous Urticaria: An Encouraging Therapeutic Approach

Abstract

Background: Chronic spontaneous urticaria (CSU) is a frequent mast cell-driven disease that affects approximately 0.5–1% of the population. Antihistamines are currently the drugs of choice in patients with CSU. Omalizumab has been shown to be very effective in CSU and has been recently approved as second-line therapy. However, although its introduction has markedly improved the therapeutic possibilities for CSU, there is still a hard core of patients who do not respond and require effective treatment. Methods: We report the case of a patient who achieved an 8-month remission of refractory CSU following the use of rituximab, and perform a review of the literature regarding the use of rituximab in CSU. Results: There was a remarkable improvement in her CSU after the administration of rituximab maintained over time. Conclusion: Rituximab is a chimeric murine/human monoclonal antibody directed against CD20, which depletes memory B-lymphocytes that are necessary for autoantibody production. The abrogation of the autoantibody production is the proposed mechanism by which it may alleviate the symptoms of CSU.

New treatments for chronic urticaria

“…Rituximab has been reported to be effective in several cases of autoimmune CSU refractory to antihistamines, omalizumab, and/or immunosuppressive therapy. 40 According to 1 report, 4 of 5 patients with CSU showed improvement within 1 to 6 weeks after rituximab infusions with improvement duration of more than 8 months. Completed RCTs are missing (1 RCT was stopped because of safety concerns [NCT00216762]), and the potential adverse effects of rituximab limit its use in CSU.…”

Monoclonal Antibodies in Treating Chronic Spontaneous Urticaria: New Drugs for an Old Disease

“…Twenty-nine articles and trials with preliminary results met the eligibility criteria (overall, 3110 patients) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. They will be discussed in the following paragraphs.…”

New Biological Treatment Options in CSU

“…Due to the autoimmune nature of CSU, it seems reasonable that the reduction of memory B cells and a subsequent decrease of the autoantibodies due to Rituximab, could well become a beneficial treatment option, particularly in autoimmune CSU. So far, only five patients in whom severe CSU refractory to immunosuppressive treatments, have been treated with rituximab [47][48][49][50][51]. The treatment regimen in these patients was either as used in lymphoma (375 mg/m2 weekly for 4 weeks) or as used in the RA protocol (two doses of 1000 mg with a 2-week interval).…”