Korean J Dermatol.  2021 Mar;59(3):175-180.

Omalizumab for Cyclosporine-resistant Chronic Spontaneous Urticaria: A Retrospective Study of a Single Center

• Kim HJ
• Kim Wi
• Shin K
• Son JH
• Lee WK
• Kim HS
• Kim B
• Kim MB
• Ko HC

Abstract

Background
Cyclosporine is a recommended third-line treatment for chronic spontaneous urticaria (CSU) that is resistant to H1-antihistamines according to the EAACI/GA ² LEN/EDF/WAO guidelines for management of urticaria. However, some patients with refractory urticaria do not respond to cyclosporine or antihistamines. Omalizumab, a humanized anti-immunoglobulin E antibody, has been shown to be effective and safe for antihistamine-resistant CSU. However, there are few reports on the efficacy of omalizumab in patients with CSU who are resistant to cyclosporine.
Objective
To evaluate the efficacy of omalizumab in patients with cyclosporine-resistant CSU.
Methods
Recalcitrant CSU patients who had symptoms (seven-day urticaria activity score, UAS7≥7) despite being administered cyclosporine (3∼5 mg/kg/day) and H1-antihistamine at up to a four-fold increased dose for 4 weeks were included in this study. Omalizumab was administered at 150 mg or 300 mg by subcutaneous injection every 4 weeks. Efficacy was assessed using UAS7 12 weeks after the initial administration of omalizumab.
Results
A total of 28 patients (18 women, 10 men) with an average age of 43.8 years were included in the study. The mean duration of CSU was 40.0 (2∼288) months, and the mean UAS7 at baseline was 14.2 (9∼35) months. Overall, 22 patients (78.6%) showed a complete (UAS7=0) or partial response (0＜UAS7≤6) at 12 weeks. Patients who were administered 300 mg of omalizumab had a more complete response (9/15, 60%) than those who were treated with 150 mg (3/13, 23.1%).
Conclusion
Omalizumab is an effective therapy for CSU patients who do not respond to cyclosporine.

Keyword

Chronic spontaneous urticaria; Cyclosporine; Omalizumab; Resistant