Omalizumab is a safe and effective therapy for elderly patients with urticaria who present with multiple comorbidities, according to a recent study published in Dermatologic Therapy. Chronic spontaneous urticaria (CSU) in elderly patients can seriously impair their quality of life (QoL), explain the study’s authors. “Therapeutic management of the elderly patient is challenging,” they write. “The first-line recommended therapy for urticaria symptom control are antihistamines, which may have interactions or increased risk of side effects in patients with comorbidities and poly-pharmacological regimens,” they write.

The impact of CSU on patients’ daily routines is tremendous, regarding QoL, sleep, stigma, and mental health, according to the study’s authors. “Chronic skin diseases in aging patients are more challenging than in younger patient populations for several reasons. First, the aging process may interfere with pharmacokinetics and pharmacodynamics, resulting in different treatment responses. Moreover, the assumption that elderly patients will be treated with additional multiple drugs increases the risk of adverse drug reactions and drug-drug and drug-disease interactions. Finally, the compliance with therapies can be particularly weak among the elderly.”

Omalizumab is a unique anti-IgE (humanized) monoclonal antibody recommended as third-line therapy for the treatment of CSU that is has proven to be resistant to antihistamines. “Biologic drugs have revolutionized the treatment of many illnesses, thanks to their specificity, ease of administration, and safety,” the authors write. “All these properties would appear to be greatly beneficial to elderly patients with a chronic skin condition.”

No Significant Link Between Treatment Effectiveness, Comorbidities

 Since real-life data focusing on patients older than 65 years of age treated with omalizumab are rare, the researchers conducted a retrospective study with the aim of assessing the efficacy and safety omalizumab in this patient population. Disease severity was evaluated using the Urticaria Activity Score-7 (UAS-7), a tool for self-assessment of wheals and pruritus with maximum score of 42. At baseline, the average UAS-7 was 27.9 ± 5 (range: 20-42), showing a rather high baseline average of disease severity.

Sixty-three patients (mean age, 72.3 ± 5.6 years; range: 65‐89) were enrolled in the study. All patients were treated at one of four different dermatologic units from January 2019 to January 2020. Omalizumab was administered subcutaneously at label dosage of 300 mg every 4 weeks. Of total subjects, 23 (36.5%) had an “early complete response” profile, which means the achievement of a UAS-7 score of “0” within the first 7 days of therapy. The most frequent comorbidity was hypertension, which affected 26/63 (41.3%) patients. The only reported side effect was asthenia, which developed in two female patients 1 day following the injection, which spontaneously resolved within 48 hours. No adverse events were reported and no significant correlations were found between treatment effectiveness and comorbidities.

“Our data suggest that omalizumab is effective and safe in patients with refractory CSU who are 65 years or older,” the authors write. “This aspect is very relevant if we consider the increasing number of elderly individuals worldwide and the huge impact of on their QoL. Future studies should focus on the relationship between drugs and aging, identifying potential mechanisms through which design of ‘tailored’ treatment regimens for elderly patients may be achieved.”

 

It’s Never Too Late to Treat Chronic Spontaneous Urticaria With Omalizumab: Real‐Life Data From Aa Multicenter Observational Study Focusing on Elderly Patients

https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.14841