Role of Biologics and Future Perspectives in the Treatment of Urticaria

Abstract

Purpose of review The management of chronic urticaria has substantially changed with the introduction of omalizumab to the treatment. Omalizumab did not only provide marked improvement in the treatment of the disease but also opened new horizons for the understanding of the pathways involved in the pathogenesis. But because of its requirement of hospital visits, cost, and only providing symptomatic relief, novel therapeutic targets are needed. Anti-IgE has gained a special interest given the high efficacy of omalizumab. Recent findings New anti-IgE modalities include quilizumab, ligelizumab (QGE031), IgE-R419NFc3-4, MEDI4212, and DARPins. Biologicals that have been used off-label include TNF-α-antagonists and anti-CD20 treatment. There are ongoing clinical trials for IL-1 inhibitors, IL-5 inhibitors, and Bruton kinase inhibitors. As novel therapeutic targets are being studied, more questions will be answered about the pathogenesis and the ultimate goal of treatment will be moved forward to provide complete remission instead of symptomatic relief. Summary This review focuses on biological treatments for chronic urticaria emphasizing particularly on the clinical efficacy, mechanism of action, and long-term treatment with omalizumab as well as other biologicals that have been used and are still under investigation for the treatment of this challenging disease.