Combination therapy with omalizumab and an immune-suppressive agent for resistant chronic spontaneous urticaria - A real-life experience

摘要: Background Chronic Spontaneous Urticaria (CSU) is a relatively common immune mediated disease that can be effectively treated nowadays. Nevertheless, for some patients remission cannot achieved following current treatment recommendations, defined as resistant CSU (r-CSU). Treating r-CSU challenging, and, currently, there are no recommended interventions. In this real-life study we describe successful therapy of 18 using an "intensified protocol" anti-IgE-antibody (omalizumab) concomitantly with immunosuppressant. We the phenotype and compared it to omalizumab-responsive (Or-CSU) phenotype. Methods Clinical serological data 72 (ie, 54 age sex matched Or-CSU) were retrospectively collected analyzed. All diagnosed ≥6 months at Sheba Medical Center during 2013-2018. Results Of 289 patients, (6%) including omalizumab cyclosporine-A (16p), methotrexate (1p), azathioprine (1p). which, 14/18 (78%) complete remission, 2/18 (11%) partial remission. During follow-up serious adverse events documented. received higher doses antihistamine (p < 0.0001) (425 ± 58 mg/month vs. 283 ± 86 mg/month; p < 0.0001) Or-CSU. The was linked concomitant autoimmunity (p = 0.0005) lower level IgE prior initiation (p = 0.027). Conclusion may distinct characterized by severe disease, autoimmunity, baseline-IgE levels (low "autoallergy"). An immunosuppressive agent found efficacious safe r-CSU. Further larger studies required verify these results.