Therapeutic Strategy According to Differences in Response to Omalizumab in Patients With Chronic Spontaneous Urticaria

Abstract

Chronic spontaneous urticaria (CSU) is a heterogeneous condition that can severely impact quality of life, which is why rapid disease control is essential. Symptomatic first-line treatment of CSU is the licensed dose of second-generation H1 antihistamines. For second-line treatment, this dose may be increased by up to four times. In patients who fail to respond to these higher doses of H1 antihistamines, treatment with omalizumab (up to 24 weeks) is recommended to achieve disease control. After this 24-week period, the patient response profile to omalizumab should be defined in order to identify refractory patients. The optimal management approach for refractory patients has not been established. In this context, the aim of the present expert consensus study involving a group of specialists (allergists and dermatologists) with specific expertise in treating urticaria was to define specific patient profiles based on their differing responses to omalizumab. Another objective was to develop a treatment algorithm based on the specific response profile. First, a comprehensive literature review was conducted. Then, a group meeting was held to discuss all issues related to the therapeutic management of these patients that had not been addressed in any previous studies. In all cases, the experts considered both the available evidence and their own clinical experience with omalizumab. We believe that implementation of this proposed algorithm will help to optimise the management of CSU patients who are refractory to antihistamine treatment, reduce disease-related costs, and improve QoL.

Omalizumab Updosing in Chronic Spontaneous Urticaria: an Overview of Real-World Evidence

“…Chronic spontaneous urticaria (CSU), a subgroup of chronic urticaria, is defined as the spontaneous daily, or almost daily, occurrence of itchy hives (wheals), angioedema, or both, lasting for 6 weeks or more, with no apparent external trigger [ 1 ]. CSU presents a major burden of disease for patients and society with a significantly diminished quality of life [ 2 , 3 ]. The estimated lifetime point prevalence of CSU is approximately 0.5–1% and nearly 60% of patients with CSU continue to have the disease despite treatment with antihistamines at the licensed dose [ 4 – 6 ].…”

“…Some reports have shown examples of the optimization of omalizumab treatment in patients who show inadequate response by increasing the dose or decreasing the dosing intervals [ 27 ]; a more flexible treatment regimen rather than a constant regimen including shortening dosing interval or augmenting dose based on the patient’s symptoms is also likely to provide better symptom control [ 28 , 29 ]. Although there is currently no algorithm for the individualized management of omalizumab treatment that is agreed on, treatment algorithms based on specific response profiles of patients refractory to AHs have been proposed to facilitate clinical management of omalizumab and enable clinicians to assess therapeutic strategy [ 2 , 30 , 31 ]. The aim of this article is to provide a summary of the published real-world evidences for the updosing of omalizumab in the treatment of CSU.…”

Analysis of the long‐term economic burden of omalizumab on patients with chronic spontaneous urticaria

“…They reported that 34% of physicians discontinued OMA, 32% extended the interval and 4.2% reduced the dose after obtaining complete response. Other reports have also suggested the dose reduction or the interval extension of OMA after achieving relief of urticarial symptoms 17–20 . These dose reductions, interval extensions and discontinuation of OMA mainly contribute to reduce economic burden on patients and society.…”

The challenges of chronic urticaria part 2: Pharmacological treatment, chronic inducible urticaria, urticaria in special situations

“…In addition to binding to serum IgE which results in a decrease of total and autoantigen-specific IgE levels, other potential mechanisms of action to explain OMA efficacy in CSU have been proposed 15 ( Table 1 ).…”