Multiple studies have proven the benefits of omalizumab in patients with chronic spontaneous urticaria (CSU).  Real-life data on the efficacy and safety of omalizumab treatment in chronic inducible urticaria (CIndU) are limited, however.

For a paper published in Clinical & Experimental Allergy, the researchers sought to explore the effects and features of complete and fast response of omalizumab treatment in CIndU. They performed a retrospective observational study at the Urticaria Center of Reference and Excellence (UCARE) between February 2018 and September 2020.  To be started on omalizumab therapy, patients had to be older than 18 years and unresponsive to second generation H1-antihistamines; patients treated with omalizumab for any other indication were excluded. The diagnosis of CIndU was based on patient history, clinical picture, and specific provocation tests.

Significant Improvement in Quality of Life

All participants received 300 mg of omalizumab every month for up to 6 months; 59 patients were included at baseline and received the first treatment. Fifty-six, 47, 46, 45, and 36 patients received treatment at the end of the first through fifth month, respectively.

Forty-six patients (78.0%) achieved well-controlled disease during the course of their omalizumab treatment, the researchers observed.  Of these, 71.7% were complete responders. Of all (n = 33) complete responders at any time during their treatment, 60.6% (n = 20) responded within 2 months (fast responders), 15 of them (75.0%) within the first month.

“Patients with chronic inducible urticaria treated with omalizumab experienced significant improvement in their QoL,” the study’s authors write.  “Forty-nine (83.1%) showed a reduction of their Dermatology Life Quality Index (DLQI) score from baseline by more than 4, the minimum clinical importance difference. In addition, DLQI scores dropped to 1 or 0 (no QoL impairment) in 36 (59.3%) patients. Of all patients (n = 36) who achieved complete normalization of their QoL at any time during the treatment, 26 (72.2%) did so within the first 2 months and 16 (64.4%) within the first month.”

Study to Identifies Predictors of Complete & Fast Response

The study team observed that patients with complete response to omalizumab (n = 17) were younger, had a longer omalizumab treatment duration, and higher baseline total IgE levels than those without.  None of the patients who achieved complete response reported adverse effects due to their omalizumab treatment, and the treatment was generally well tolerated.

All patients (n = 5) with baseline IgE <40kU/L failed to achieve complete response to omalizumab.  They also observed no statistically significant differences between complete and incomplete responders with respect to gender, Urticaria Control Test (UCT) scores at baseline, DLQI scores at baseline, disease duration, autologous serum skin test results, comorbid CSU, and subforms of CIinU.

“Our study is the first to identify predictors of complete response and fast response to omalizumab treatment in patients with CIinU and also one of the first to show that omalizumab treatment is linked to positive effects on life quality in patients with CIinU,” the study’s authors write.  “Our study suggests that omalizumab is associated with rapid and significant improvement of disease control and QoL in CIinU, especially in patients with high IgE. These results, if confirmed by future studies, may help to guide patients’ and physicians’ expectations when omalizumab is used to treat CIndU.”

<READING AND RESOURCES>

Omalizumab in Chronic Inducible Urticaria: A Real‐life Study of Efficacy, Safety, Predictors of Treatment Outcome and Time to Response

https://onlinelibrary.wiley.com/doi/10.1111/cea.13838