Real-life experiences with omalizumab for the treatment of chronic urticaria.
BACKGROUND
Evidence has shown that omalizumab, a subcutaneous anti-IgE monoclonal antibody, is highly effective for the treatment of chronic urticaria.


OBJECTIVE
To evaluate omalizumab 150 mg/month in severe, difficult-to-treat, chronic urticaria in a real-life setting.


METHODS
This prospective open-label study evaluated of 150 mg of omalizumab in severe urticaria defined by a 7-day urticaria activity score (UAS-7) higher than 30, a history of oral glucocorticoid use, and by suboptimal response to previous treatments. Two subgroups of patients at different centers (Toronto and Quebec City, Canada) were included. The primary efficacy evaluation was a change in UAS-7 from baseline. A quantitative medication score assessed the use of other anti-urticarial medications.


RESULTS
Sixty-eight patients were included: 61 with chronic spontaneous urticaria, 6 with cold urticaria, and 1 with urticarial vasculitis. Patients were followed for up to 25 months. In Toronto, mean UAS-7 decreased from 32.2 at baseline to 5.7 after the last omalizumab treatment. Seventy-nine percent achieved complete remission during omalizumab therapy (UAS-7 0) and 6 (18%) showed improvement but never achieved complete remission. The most common maintenance dosing intervals were 1 to 3 months. In Quebec City, from baseline to 18 months, mean UAS-7 decreased from 24.4 to 2.2 and the quantitative medication score decreased from 13.3 to 3.0. All 6 patients with cold urticaria became symptom free, with a significant decrease of their cold stimulation tolerance test.


CONCLUSIONS
Omalizumab 150 mg was effective in difficult to treat patients with severe, chronic urticaria refractory to recommended treatments who usually required prednisone. Omalizumab induced a long-lasting positive response and was well tolerated without side effects.
Division of Allergy and Clinical Immunology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: gsussman@rogers.com.
Gordon
G
Sussman
Centre de recherche appliquée en allergie de Québec, Laval University, Quebec City, Quebec, Canada.
Jacques
J
Hébert
Division of Allergy and Clinical Immunology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Carly
C
Barron
Division of Allergy and Clinical Immunology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Jia
J
Bian
Centre de recherche appliquée en allergie de Québec, Laval University, Quebec City, Quebec, Canada.
Rose-Marie
RM
Caron-Guay
Centre de recherche appliquée en allergie de Québec, Laval University, Quebec City, Quebec, Canada.
Stéphanie
S
Laflamme
Division of Allergy and Clinical Immunology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Simon
S
Stern
D000293:Adolescent; D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000008:administration & dosage* / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D002648:Child; D002908:Chronic Disease; D056587:Cryopyrin-Associated Periodic Syndromes / Q000188:drug therapy; D015536:Down-Regulation / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007073:Immunoglobulin E / Q000096:biosynthesis / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D000069444:Omalizumab; D011446:Prospective Studies; D012720:Severity of Illness Index; D014581:Urticaria / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology*; D055815:Young Adult
D000888:Antibodies, Anti-Idiotypic; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D000069444:Omalizumab; D007073:Immunoglobulin E