DUPILUMAB AS A POTENTIAL DISEASE-MODIFYING INTERVENTION FOR CHRONIC SPONTANEOUS URTICARIA: 3-YEAR FOLLOW-UP RESULTS

Abstract

<h3>Introduction</h3> Omalizumab, a monoclonal anti-IgE antibody, has been previously shown to be effective in patients with CSU where first- and second-line therapies have been unsuccessful. However, there is more evidence suggesting that omalizumab cannot achieve well-controlled CSU in a significant percentage of these patients. <h3>Methods</h3> Six patients diagnosed with CSU, who failed to respond to antihistamines and prolonged (>1 year) therapy with omalizumab at increased doses (300-600 mg monthly) were followed in this study, for up to 34 months following initiation of dupilumab therapy. <h3>Results</h3> The cohort demonstrated an initial mean UAS of 37.4 (SD 4.04). Of these six patients, one remained uncontrolled in spite of dupilumab and was given omalizumab as an add-on therapy 9 months after initiating dupilumab. Another patient was unable to afford to continue dupilumab and had a lapse of receiving dupilumab for 18 months and was restarted on dupilumab through compassionate access. CSU remission was therefore not achieved in these two patients. The other four patients presented in our original paper however showed that UAS remained zero, at 14-22 months follow up since discontinuation of dupilumab. <h3>Conclusion</h3> By demonstrating the maintenance of CSU remission with dupilumab following discontinuation of therapy, in 67% of the patients, over an observation period up to 22 months, this is the first case series that highlights dupilumab's potential disease-modifying efficacy in patients impacted by this disease. This suggests that discontinuation of dupilumab can be an effective therapy that accomplishes clinical resolution while limiting unnecessary exposure and costs of requiring maintenance biologic and other therapies.