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Long‐term management of chronic spontaneous urticaria with omalizumab
Author(s) -
Pinto Gouveia M.,
Gameiro A.,
Pinho A.,
Gonçalo M.
Publication year - 2017
Publication title -
clinical and experimental dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.587
H-Index - 78
eISSN - 1365-2230
pISSN - 0307-6938
DOI - 10.1111/ced.13173
Subject(s) - medicine , omalizumab , refractory (planetary science) , chronic urticaria , clinical trial , confidence interval , prospective cohort study , gastroenterology , surgery , immunoglobulin e , antibody , immunology , physics , astrobiology
Summary Background Clinical trials have shown the efficacy of omalizumabs efficacy in refractory chronic spontaneous urticaria ( CSU ) and chronic inducible urticaria ( CI ndU), but real‐life management strategies are lacking. Aim To assess the long‐term efficacy and safety of omalizumab, and to identify predictive factors and optimum dosage regimens. Methods This was a prospective study of 13 patients (11 women, 2 men) with severe CSU [weekly urticaria activity score ( UAS 7) > 28] resistant to anti‐H1 antihistamines. Patients were started on omalizumab 150 mg subcutaneously every 4 weeks. Dose and interval between administrations were adjusted according to clinical response (189 administrations; treatment duration range 2–38 months). Results Mean UAS 7 was 36.3 ± 5.4. Of the 13 patients, all had experienced angio‐oedema, while in addition, 7 had delayed pressure urticaria ( DPU ) and 1 had solar urticaria ( SU ). After omalizumab treatment, 4 (30.8%) of the 13 patients had complete response ( CR ), and the remaining 8 (61.5%) had partial response. CR was achieved with a dose of 150 mg every 4 ( n = 2 patients) or 5 ( n = 2) weeks. One of these patients remained disease‐free after stopping treatment. Partial responses were achieved with 150 mg every 4 weeks ( n = 4) and with 300 mg ( n = 4) at intervals of 5 weeks ( n = 1), 4 weeks ( n = 2) or 3 weeks ( n = 1). Only one patient (7.7%) did not show significant improvement, despite a dose of 300 mg every 4 weeks. There were no significant differences in epidemiological, clinical and laboratory data between the different response groups. Only two adverse events were observed: one was mild headache and the other was severe angio‐oedema and aggravation of urticaria within 6 h of omalizumab administration. Conclusion Omalizumab dose and interval between administrations could be individualized for long‐term management of CSU .