Quality of life improves with dupilumab for patients with chronic spontaneous urticaria

Key takeaways:

• Itching and hives in chronic spontaneous urticaria impact sleep and self-esteem.
• The treatment group had more patients who reported that the disease had little to no impact on quality of life.

WASHINGTON — Patients with chronic spontaneous urticaria experienced better quality of life with dupilumab compared with placebo, according to two posters presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“Chronic spontaneous urticaria is a horrible disease,” Marcus Maurer, MD, PhD, executive director of the Institute of Allergology at Charité – Universitätsmedizin Berlin, told Healio.

Physicians and even patients often underestimate the impact that this devastating disease has on quality of life, Maurer said.

“Right now, one in 10 patients with chronic spontaneous urticaria gets the treatment they need,” Maurer said.

In the United States, omalizumab (Xolair; Genentech, Novartis) is the only drug that has been approved to treat chronic spontaneous urticaria, Maurer said, although dupilumab (Dupixent; Regeneron/Sanofi) has been approved for treatment in Japan.

“Sixty percent of all chronic spontaneous urticaria patients right now stop seeing a doctor because they believe we can’t help them,” Maurer said. “We need better treatment options.”

During LIBERTY-CSU CUPID Study A, the researchers treated 137 patients aged 6 years and older whose chronic spontaneous urticaria had not been adequately controlled with H1 antihistamines with dupilumab or placebo instead for 24 weeks.

“This is a drug that physicians are already quite familiar with, especially dermatologists,” Maurer said.

Patients completed the 23-item Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) at baseline and at 24 weeks.

“This is a disease-specific tool,” Maurer said. “It asks questions that specifically assess the impairment of quality of life in patients with chronic urticaria.”

Patients also completed the 10-item Dermatology Life Quality Index (DLQI) at baseline and at 24 weeks.

“You can measure in chronic spontaneous urticaria patients the quality-of-life impairment and compare it to that in psoriasis patients and in [atopic dermatitis] patients,” Maurer said.

Higher totals in both instruments indicate worse quality of life.

At baseline, mean CU-Q2oL scores included 46.7 for the placebo group (n = 68) and 41 for the dupilumab group (n = 69).

Also at baseline, 83.8% of the placebo group and 85.5% of the dupilumab group said that the impact of itching on their lives was “very much” or extreme. Hives had a “very much” or extreme impact on 76.5% of the placebo group and 81.2% of the dupilumab group at baseline.

“They go crazy literally sometimes because they’re so itchy,” Maurer said.

Other areas where chronic spontaneous urticaria had a “very much” or extreme impact on life included sleep, embarrassment, physical activity and wardrobe.

“What happens when you treat them?” Maurer asked.

At week 24, the proportion of patients who reported that chronic spontaneous urticaria had no or little effect on the items queried in CU-Q2oL was significantly greater in the treatment group compared with the placebo group.

“This is a disease-specific tool,” Maurer said.

For example, 60% of those in the dupilumab group and 36.8% of those in the placebo group said itching had little or no impact on their lives.

“If you asked urticaria patients, ‘What do you expect from your treatment?’ The first thing they will say is, ‘Get rid of that stupid itch!’ That’s what I think the major benefit is that we’re seeing,” Maurer said.

Similarly, 68.6% of the dupilumab group and 36.8% of the placebo group said hives had little or no impact.

“The rate of people who have no more quality-of-life impairments or very little based on this assessment is much higher in those receiving dupilumab compared to those who have placebo,” Maurer said.

At baseline, 73.1% of the placebo group (n = 67) and 65.2% of the dupilumab group (n = 67) had DLQI scores indicating that chronic spontaneous urticaria had a very or extremely large effect on their lives.

When asked how itchy, sore, painful or stinging their chronic spontaneous urticaria was in the DLQI at baseline, 91% of the full cohort said “a lot” or “very much.” Similarly, 55.6% said they were “a lot” or “very much” embarrassed or self-conscious.

Greater than 50% reported interference with shopping or taking care of their home or yard; an influence on what they wore; and effects on their social and leisure activities at baseline as well.

At week 24, 73.1% of the dupilumab group and 46.3% of the placebo group said that their chronic spontaneous urticaria had no effect or a small effect on their lives in the DLQI (OR = 4.27; 95% CI, 1.84-9.89).

The dupilumab group also had a significantly greater proportion of patients who reported that their disease had no effect or a little effect on all 10 items on the DLQI, compared with the placebo group, at week 24.

Maurer said that physicians should begin treating patients with dupilumab.

“Treat the disease until it is gone. That means treat it so that patients forget that they have the disease,” he said. “They want to normalize their quality of life. We want to give them complete control. This is how we make them as normal as we can get.”

Maurer also acknowledged the difference between current care and that goal.

“Chronic spontaneous urticaria in some derm communities is not very well treated,” Maurer said. “Bring it to patients. License it. Label it.”

Still, Maurer remained optimistic.

“This will change things, and it will bring more patients to effective treatment,” he said.

Reference:

• Maurer M, et al. J Allergy Clin Immunol. 2024;doi:10.1016/j.jaci.2023.11.032.
• Maurer M, et al. J Allergy Clin Immunol. 2024;doi:10.1016/j.jaci.2023.11.033.
• Maurer M, et al. Poster 007. Presented at: AAAAI Annual Meeting; Feb. 23-26, 2023; Washington, D.C.

For more information:

Marcus Maurer, MD, PhD, can be reached at marcus.maurer@charite.de.