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Is it possible to predict the return of CSU symptoms after stopping omalizumab treatment?

Published online: April 12, 2018

Chronic spontaneous urticaria (CSU) is a disease where hives and/or deep tissue swelling (angioedema) appear frequently without a known trigger or warning. It is a debilitating disease with negative effects on quality of life, which may include sleep deprivation, depression, and anxiety. Until recently, there was no available therapy for patients with CSU who remain symptomatic despite antihistamine treatment. Omalizumab, a humanized antibody that blocks immunoglobulin E (IgE), has proven effective at achieving symptom control in patients with CSU not responding to antihistamines; however, symptoms can return after treatment discontinuation.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Ferrer and colleagues analyzed data from two clinical trials, including 642 patients, to identify potential predictors of the speed of symptom return after stopping omalizumab treatment. The authors used a sophisticated mathematical model to determine the predictive potential of 746 variables, which included baseline (i.e. start of treatment) patient characteristics and disease measures, such as IgE levels, weekly urticaria activity score (UAS7), and pre- and post-baseline medications.

Only two variables were identified as predictors of the reappearance of symptoms: baseline UAS7 (this score reflects the severity of symptoms based on the number of hives and itch intensity) and the speed of response to treatment. The results suggest that patients with worse symptoms before treatment (i.e., higher UAS7 score) and slow response to omalizumab treatment have a higher probability of rapid symptom return after treatment discontinuation. In contrast, those with a lower UAS7 score at baseline and fast response to omalizumab have a lower probability of rapid symptom return.

The results of this analysis suggest that it is possible to accurately predict which patients are at risk of rapid symptom return after omalizumab treatment discontinuation. These results open the possibility of developing a simple digital tool based on clinical features to estimate the probability of rapid symptom return. This could improve the therapeutic management of patients with CSU in the clinic.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.