Proença Miguel, Marcelino João, Vieira João, Guimarães Joana, Dias Carlota, Tomaz Elza
Immunology and Allergy Department, Unidade Local de Saúde Arrábida, Portugal.
Charité - Universitätsmedizin Berlin, Germany.
Asia Pac Allergy. 2025 Sep;15(3):159-165. doi: 10.5415/apallergy.0000000000000162. Epub 2025 Jan 8.
Real-life clinical research on biomarkers that predict therapy outcomes of severe chronic spontaneous urticaria patients receiving omalizumab (OMA) therapy is still limited. For this reason, we aimed to identify biomarkers that predict the response to OMA treatment.
A single-center, observational, retrospective review of patients with severe chronic urticaria treated with OMA from January 2015 to January 2023 in a Portuguese Immunology and Allergy Department. One-way ANOVA and linear regression were used.
Data on 56 OMA-treated chronic spontaneous urticaria patients shows patients can be divided into 3 groups according to their response to OMA. The first group of 26 patients (46.4%) successfully reduced their IMA dose without experiencing any rebound effects. The second group of 19 (33.9%) patients achieved disease control but could not tolerate a progressive dose reduction, and the third group of 11 (19.6%) patients, required a higher dose to achieve disease control. In group 1, patient age and a favorable clinical response had a positive correlation ( = 0.008). The patient's age was also correlated to the time interval until a dose reduction was tolerated ( = 0.69; = 0.005). There was also a negative correlation between the ratio: thyroid peroxidase antibodies/total-IgE and a favorable clinical response ( = -0.74; = 0.021). In group 2, thyroid peroxidase antibodies were negatively correlated with a favorable clinical response ( = -0.55; = 0.027). In group 3, anti-double-stranded DNA was negatively correlated with a favorable clinical response ( = -0,97; = 0,007).
Our study suggests that older patients experience higher success rates with OMA compared to younger individuals, but increasing age is also associated with a longer interval before achieving successful dose reduction. Potential markers of resistance to OMA identified in our cohort included elevated levels of IgG-antithyroid peroxidase antibodies, positive anti-dsDNA antibodies, and a higher IgG-antithyroid peroxidase/total-IgE ratio.
关于预测接受奥马珠单抗（OMA）治疗的重度慢性自发性荨麻疹患者治疗结果的生物标志物的真实临床研究仍然有限。因此，我们旨在确定预测对OMA治疗反应的生物标志物。
对2015年1月至2023年1月在葡萄牙一家免疫与过敏科接受OMA治疗的重度慢性荨麻疹患者进行单中心、观察性、回顾性研究。采用单因素方差分析和线性回归。
56例接受OMA治疗的慢性自发性荨麻疹患者的数据显示，患者可根据对OMA的反应分为3组。第一组26例患者（46.4%）成功降低了OMA剂量，且未出现任何反弹效应。第二组19例患者（33.9%）实现了疾病控制，但无法耐受逐步降低剂量，第三组11例患者（19.6%）需要更高剂量才能实现疾病控制。在第一组中，患者年龄与良好的临床反应呈正相关（=0.008）。患者年龄还与直至耐受剂量降低的时间间隔相关（=0.69；=0.005）。甲状腺过氧化物酶抗体/总IgE比值与良好的临床反应之间也呈负相关（=-0.74；=0.021）。在第二组中，甲状腺过氧化物酶抗体与良好的临床反应呈负相关（=-0.55；=0.027）。在第三组中，抗双链DNA与良好的临床反应呈负相关（=-0.97；=0.007）。
我们的研究表明，与年轻个体相比，老年患者使用OMA的成功率更高，但年龄增长也与成功降低剂量前的间隔时间延长有关。我们队列中确定的对OMA耐药的潜在标志物包括抗甲状腺过氧化物酶IgG抗体水平升高、抗双链DNA抗体阳性以及更高的抗甲状腺过氧化物酶IgG/总IgE比值。
