Omalizumab for the treatment of chronic urticaria

Abstract

Urticaria is a common and often debilitating dermatological condition defined by the sudden appearance of wheals, angioedema or both. It is further classified into specific subtypes based on duration and specific triggers. Awareness and understanding of urticaria are important to ensure a correct initial diagnosis and initiate appropriate guideline-based treatment outlining a stepwise approach. However, in chronic urticaria, approximately 50% of patients are refractory to the first step, the use of licensed doses of second-generation H1-antihistamines. If the second step, an increase in the dose of the second-generation H1-antihistamines, is also not successful, in the third step omalizumab (Xolair™, Novartis Pharma AG^©/Genentech, Inc.^©), an anti-IgE therapy, is recommended as an add-on. Of all alternative treatments mentioned in the guidelines, omalizumab is currently the only licensed treatment for H1-antihistamine-refractory chronic spontaneous urticaria, has a favorable risk/benefit ratio and was well tolerated in clinical studies.

Keywords:

• Anti-IgE
• chronic idiopathic urticaria
• chronic spontaneous urticaria
• omalizumab
• urticaria

Acknowledgements

Novartis Pharma AG, Basel, Switzerland, provided support for the preparation of this article but did not pay any honoraria to the authors. Editorial support was provided by professional medical writer A Goonesinghe, PhD (CircleScience, part of KnowledgePoint 360, an Ashfield Company), funded by Novartis Pharma AG.

Financial & competing interests disclosure

Novartis Pharma AG (Basel, Switzerland) provided support for the preparation of this article, M Maurer has received research support and/or honoraria for consulting and/or lectures from Abbot, Allmiral, FAES, Genentech, MSD, Moxie, Novartis, Sanofi, Takeda, UCB and Uriach. T Zuberbier has received consulting fees from AnseIl, Bayer Schering, DST, FAES, Fujisawa, HAL, Henkel, Kryolan, Leti, Menarini, Merck, MSD, Novartis, Procter and Gamble, Ranbaxy, Sanofi-Aventis, Schering Plough, Stallergenes, Takeda, UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• There is a high burden of disease in patients with chronic spontaneous or inducible urticaria.

• Current treatment options for patients with refractory chronic spontaneous or inducible urticaria are limited.

• Omalizumab is an effective and well-tolerated, guideline-recommended add-on treatment option for all types of chronic urticaria with inadequate response to H1-antihistamine treatment.

• Omalizumab has been recently approved in the EU, USA and many other countries for as an add-on therapy H1-antihistamine-refractory chronic spontaneous urticaria.

• Further research will help to elucidate the mode of action of omalizumab in chronic spontaneous urticaria.

Notes