Department of Dermatology, Koc University, School of Medicine, Istanbul, Turkey.
Department of Dermatology, Uludag University, School of Medicine, Bursa, Turkey.
An Bras Dermatol. 2022 Sep-Oct;97(5):592-600. doi: 10.1016/j.abd.2022.03.003. Epub 2022 Jul 16.
Chronic Spontaneous Urticaria (CSU) is characterized by recurrent wheals and/or angioedema for longer than 6-weeks. Guidelines recommend Omalizumab (Oma) as first-line and Cyclosporine-A (Cs-A) as second-line treatment in antihistamine resistant CSU. This step-wise algorithm might be time-consuming and costly.
To determine indicators of response to Oma or Cs-A in CSU patients.
We retrospectively analyzed data from seven centers in Turkey; the inclusion criteria for patients were to receive both Oma and Cs-A treatment (not concurrently) at some point in time during their follow-up. Clinical and laboratory features were compared between groups.
Among 110 CSU patients; 47 (42.7%) were Oma-responders, 15 (13.6%) were Cs-A-responders, and 24 (21.8%) were both Oma and Cs-A responders and 24 (21.8%) were non-responders to either drug. High CRP levels were more frequent in Cs-A-responders (72.7% vs. 40.3%; p = 0.055). Oma-responders had higher baseline UCT (Urticaria Control Test) scores (6 vs. 4.5; p = 0.045). Responders to both drugs had less angioedema and higher baseline UCT scores compared to other groups (33.3% vs. 62.8%; p = 0.01 and 8 vs. 5; p = 0.017). Non-responders to both drugs had an increased frequency in the female gender and lower baseline UCT scores compared to other groups (87.5% vs. 61.6%; p = 0.017 and 5 vs. 7; p = 0.06).
Retrospective nature, limited number of patients, no control group, the lack of the basophil activation (BAT) or BHRA (basophil histamine release assay) tests.
Baseline disease activity assessment, which considers the presence of angioedema and disease activity scores, gender, and CRP levels might be helpful to predict treatment outcomes in CSU patients and to choose the right treatment for each patient. Categorizing patients into particular endotypes could provide treatment optimization and increase treatment success.
慢性自发性荨麻疹（CSU）的特征是反复出现风团和/或血管性水肿，持续时间超过 6 周。指南建议奥马珠单抗（Oma）作为抗组胺药耐药性 CSU 的一线治疗药物，环孢素 A（Cs-A）作为二线治疗药物。这种逐步的算法可能既耗时又昂贵。
确定 CSU 患者对奥马珠单抗或环孢素 A 反应的指标。
我们回顾性分析了土耳其 7 个中心的数据；患者的纳入标准是在随访期间的某个时间点接受过奥马珠单抗和环孢素 A 治疗（非同时）。比较了两组之间的临床和实验室特征。
在 110 例 CSU 患者中；47 例（42.7%）为奥马珠单抗应答者，15 例（13.6%）为环孢素 A 应答者，24 例（21.8%）为奥马珠单抗和环孢素 A 均应答者，24 例（21.8%）为两种药物均无应答者。Cs-A 应答者的 CRP 水平较高（72.7%比 40.3%；p=0.055）。奥马珠单抗应答者的基线 UCT（荨麻疹控制测试）评分较高（6 分比 4.5 分；p=0.045）。与其他组相比，两种药物的应答者的血管性水肿较少，基线 UCT 评分较高（33.3%比 62.8%；p=0.01 和 8 比 5；p=0.017）。与其他组相比，两种药物均无应答者中女性比例较高，基线 UCT 评分较低（87.5%比 61.6%；p=0.017 和 5 比 7；p=0.06）。
回顾性研究，患者数量有限，无对照组，缺乏嗜碱性粒细胞活化（BAT）或 BHRA（嗜碱性粒细胞组胺释放试验）检测。
基线疾病活动评估，考虑血管性水肿的存在和疾病活动评分、性别和 CRP 水平，可能有助于预测 CSU 患者的治疗结果，并为每位患者选择正确的治疗方法。将患者分为特定的表型可能提供治疗优化并增加治疗成功率。
