Türk Murat, Carneiro-Leão Leonor, Kolkhir Pavel, Bonnekoh Hanna, Buttgereit Thomas, Maurer Marcus
Division of Allergy and Clinical Immunology, Erciyes University School of Medicine, Kayseri, Turkey.
Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de São João, E.P.E., Oporto, Portugal.
J Allergy Clin Immunol Pract. 2020 Jan;8(1):113-124. doi: 10.1016/j.jaip.2019.07.021. Epub 2019 Jul 31.
Omalizumab is an effective treatment for patients with chronic spontaneous urticaria (CSU). In routine clinical practice, physicians often face complex cases of CSU and need to decide whether patients are suitable for omalizumab treatment and how to manage this therapy. Here, we provide evidence and experience-based answers to the most common and important questions on omalizumab treatment of CSU. At 4 large urticaria centers, questions on the use of omalizumab in the treatment of patients with CSU were collected and then ranked by frequency and importance and grouped into top 5 domains using an interactive consensus approach. We suggest that omalizumab can be used to treat patients with CSU with any of the 3 CSU phenotypes (wheals only, angioedema only, wheals and angioedema), with comorbid chronic inducible urticaria, with cancer, who receive other biologics or cyclosporine, or who are pregnant or want to become pregnant, or are breast-feeding. Omalizumab treatment should be started with 300 mg every 4 weeks, monitored with validated patient-reported outcome measures, and maintained, in responders, until remission of CSU. Finally, partial responders or non responders can benefit from omalizumab updosing or adding or switching to cyclosporine. We believe our suggestions on the use of omalizumab in CSU will help to inform clinical decision making. Follow-up efforts should increase, systematically review, and profile the data available and provide evidence-based recommendations on how to best use omalizumab in CSU.
奥马珠单抗是治疗慢性自发性荨麻疹（CSU）患者的一种有效药物。在常规临床实践中，医生常常面临复杂的CSU病例，需要决定患者是否适合使用奥马珠单抗治疗以及如何管理这种治疗。在此，我们针对奥马珠单抗治疗CSU最常见和重要的问题提供基于证据和经验的答案。在4个大型荨麻疹中心，收集了关于使用奥马珠单抗治疗CSU患者的问题，然后通过互动式共识方法按频率和重要性进行排序，并归为前5个领域。我们建议奥马珠单抗可用于治疗具有3种CSU表型（仅风团、仅血管性水肿、风团和血管性水肿）之一、合并慢性诱导性荨麻疹、患有癌症、正在接受其他生物制剂或环孢素治疗、怀孕或想要怀孕或正在哺乳的CSU患者。奥马珠单抗治疗应起始为每4周300mg，采用经过验证的患者报告结局指标进行监测，对于有反应者维持治疗直至CSU缓解。最后，部分反应者或无反应者可从奥马珠单抗增加剂量、加用或换用环孢素中获益。我们相信我们关于在CSU中使用奥马珠单抗的建议将有助于为临床决策提供参考。应加强随访工作，系统地审查和分析现有数据，并就如何在CSU中最佳使用奥马珠单抗提供基于证据的建议。
