D1.371 - Dupilumab for the treatment of refractory severe chronic spontaneous urticaria
Case report
Dupilumab for the Treatment of Refractory Severe Chronic Spontaneous Urticaria
Tejido-Suárez P, Cabañas R, Goyanes-Malumbres M, Hernández-Cano N, Caballero T
Allergy Department, Hospital Universitario La Paz, Madrid, Spain.
Introduction
Chronic spontaneous urticaria (CSU) is typically treated with H1 antihistamines (up to four times the standard dose) and omalizumab. Other second-line options include antileukotrienes and cyclosporine. However, refractory cases require alternative treatments. Dupilumab, a monoclonal IgG4 antibody that inhibits interleukins (IL)-4 and IL-13, has shown efficacy in CSU and inducible chronic urticaria, though it is not EMA-approved for CSU. This study presents three cases of severe CSU treated off-label with dupilumab.
Materials and Methods
We conducted a retrospective review of medical records from patients with refractory CSU treated with dupilumab. We assessed parameters such as the Urticaria Control Test (UCT), Angioedema Control Test (AECT), and quality of life questionnaires (CU-QoL, AE-QoL). Informed consent was obtained for publication.
Results
Three female patients were included, all previously treated with high-dose oral H1 antihistamines, omalizumab, montelukast, and cyclosporine. Dupilumab was proposed due to inadequate responses to omalizumab, prolonged cyclosporine use, or related side effects. Patients received a loading dose of 600 mg at week 0, followed by 300 mg biweekly. The first two patients achieved complete symptom control by week 12, while the third showed no significant improvement by week 8, although late responses to dupilumab have been noted.
Conclusions
The treatment of chronic spontaneous urticaria (CSU) is evolving rapidly, with an increasing number of therapeutic options becoming available. Biologic therapy with omalizumab has demonstrated high efficacy and a favourable side effect profile; however, refractory forms of the disease remain a therapeutic challenge. Here, we present two patients with refractory CSU who achieved complete disease control after treatment with dupilumab, another biologic therapy. Although further studies are necessary, dupilumab shows promise as a therapeutic option for recalcitrant CSU.
