Q&A: Dupilumab eases hives, itch in antihistamine-resistant chronic spontaneous urticaria
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LOUISVILLE, Ky. — Dupilumab improved chronic spontaneous urticaria among patients whose disease did not respond to H1 antihistamines, according to a presentation here.
The results were presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
Between baseline and 24 weeks, researchers noted clinically meaningful and statistically significant improvements in 7-day Itch Severity Score, Hives Severity Score and Urticaria Activity Score.
Treatment also was safe and well tolerated by the patients, who were aged 6 years and older, and improvements occurred regardless of IgE level, the researchers continued.
Healio spoke with Marcus Maurer, MD, professor of dermatological allergology, clinic for dermatology, venerology and allergology at the Charité University of Medicine in Berlin, to find out more.
Healio: What prompted this study?
Maurer: Chronic spontaneous urticaria (CSU) causes recurrent itchy hives and/or angioedema, significantly impacting quality of life. Many patients still experience a substantial disease burden despite treatment with standard-of-care antihistamines.
These data are from the LIBERTY-CSU CUPID Study A, assessing whether varying levels of IgE, a marker of disease in CSU, impact the ability of dupilumab (Dupixent; Sanofi, Regeneron) to improve itch, hives and overall disease activity for patients.
Healio: How do these results build upon previous phases of the LIBERTY study?
Maurer: These results build upon knowledge from Study A of the LIBERTY-CSU CUPID trial, showing that at 24 weeks, dupilumab significantly reduced itch, hives and overall disease activity compared with placebo, regardless of baseline IgE levels, and was well tolerated.
Healio: Were there any particularly surprising or significant results you would like to spotlight?
Maurer: We were pleased that the results continued to show a strong response across all subgroups, and reinforced dupilumab’s ability to improve itch, hives and disease activity.
Healio: What makes these results noteworthy?
Maurer: The results highlight the complex underlying biology of CSU and the role that targeting IL-4 and IL-13 can play in reducing burdensome disease symptoms like itch and hives across a patient population with diverse baseline IgE levels.
Patients with CSU often have elevated total IgE serum levels, but normal or very low total IgE levels also occur. High total IgE may represent high disease activity and longer disease duration, as well as lower chance of responding to cyclosporine. Low IgE, in contrast, may suggest type IIb autoimmune CSU and poor response to treatment with omalizumab (Xolair; Genentech, Novartis).
Healio: How can doctors use these findings to improve care?
Maurer: The potential use of dupilumab in CSU is investigational. These findings highlight how biologic treatments such as dupilumab can improve signs and symptoms of the disease for patients who do not respond to standard-of-care antihistamines.
Healio: What is the next step in this research?
Maurer: There is a need for additional treatments, as many people with CSU do not respond to available options. Continuing to study and understand how dupilumab works to help reduce symptoms, including extreme itch, in patients with CSU is important.