Dupilumab treatment as an ‘add-on’ to anti-histamines in chronic spontaneous urticaria improved urticaria activity and quality of life
In data presented at the American Academy of Allergy Asthma and Immunology (AAAAI) 2023 in San Antonio, US and published in a supplement to the Journal of Clinical Allergy and Immunology, dupilumab treatment for 24 weeks, in patients with chronic spontaneous urticaria, already taking H1-antihistamines, led to significant reductions in urticarial activity and improvements in quality of life.
Chronic spontaneous urticaria is an endogenous disorder that is strongly associated with autoimmunity, particularly with immunoglobulin G antibody to the alpha subunit of the IgE receptor. The term ‘chronic urticaria’ relates to urticaria lasting for more than six weeks and has two forms: chronic inducible urticaria and chronic spontaneous urticaria, with the latter giving rise to symptoms independent of an exogenous stimulus. Treatment guidelines published in 2022 recommend the use of second-generation H1-anti-histamines, at a dose of up to four times the usual dose. However, in 2019, a case report described use of dupilumab treatment at an initial dose of 600 mg then 300 mg every two weeks in a patient with therapy resistant chronic spontaneous urticaria. Within three months, the patient’s urticaria duration and severity resolved. Furthermore, in 2022, a randomised, placebo-controlled, phase 3 trial, of dupilumab treatment as an ‘add-on’ to therapy with either standard of < 4-fold antihistamine dosing or matching placebo, showed that after 24 weeks, the least squares mean change in the itch severity score over 7 days and the urticaria activity score over 7 days (UAS7) were both significantly reduced in those given dupilumab treatment.
Dupilumab treatment and urticarial activity
Data presented at the AAAI conference relates to the impact of dupilumab on urticarial activity score over 7 days (UAS7) and quality of life based on the dermatology quality of life index (DLQI). Patients taking an H1-antihistamine (up to fourfold approved dose) were randomised to add-on dupilumab 300 mg (or 200 mg for body weights < 60 kg but > 30 kg) or matching placebo every 2 weeks for 24 weeks.
The results showed that dupilumab treatment produced a significant improvement in the UAS7 score at week 24 (p = 0.0003) as well an improvement in the DLQI (p = 0.0026) compared to placebo.
Maurer M et al. Dupilumab Improves Urticaria Activity And Quality Of Life In Patients With Chronic Spontaneous Urticaria (CSU). J Allergy Clin Immunol 2023