Comparison between Omalizumab responders and non-responders in chronic urticaria

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Created On: 14/11/2022

A single-center retrospective research compared the clinical characteristics and laboratory findings of individuals with chronic urticaria who showed and did not show response to Omalizumab therapy.

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Key take away

Chronic urticaria patients who were atopic and had high levels of total IgE, basophils, and eosinophils responded well to Omalizumab therapy, while patients with positive thyroid autoantibodies and concurrent mental illness did not respond.

Background

A single-center retrospective research compared the clinical characteristics and laboratory findings of individuals with chronic urticaria who showed and did not show response to Omalizumab therapy.

Method

Retrospective evaluations were conducted on chronic urticaria patients who received the monoclonal antibody Omalizumab. The urticaria control test (UCT) was used to assess the therapeutic response to Omalizumab (responder to Omalizumab: UCT score ≥ 12 at six months and a rise of ≥ 3 relative to baseline). A comparison of the laboratory results and clinical characteristics of volunteers who did and did not show response to therapy was done.

Result

Notably, 220 patients who got 300 mg of subcutaneous (sc) Omalizumab every four weeks for chronic urticaria had a mean age of 38.89 ± 12.76 years, with 154 (70%) women and 66 (30%) men. At the end of six months, 189 patients (85.9%) had a significant response to Omalizumab therapy. In the Omalizumab responders, the total IgE level (median = 240.5 [45-2,644] [kU/L]), basophil count (median = 40 [0-100] [cells/µL]), eosinophil count (median = 190 [0-800] [cells/L]), and atopy (n = 73 [38.6%]) were considerably higher.

Anti-thyroglobulin (n = 11 [35.5%] [>2 IU/mL positive]) and psychiatric illness (n = 13 [41.9%]) were substantially more prevalent in Omalizumab nonresponders (UCT score ≤ 11 at 6 months). Total IgE level (r = 0.207), blood lymphocyte count (r = −0.149), blood eosinophil count (r = 0.168) and rise in UCT score were shown to have a marginally significant clinical connection. Blood basophil count (area under curve [AUC]: 0.662), total IgE level (AUC: 0.866), and blood eosinophil count (AUC: 0.763) all showed diagnostic significance to predict the response to Omalizumab therapy in chronic urticaria people, according to the ROC curve assessment.

Conclusion

Urticaria patients with concurrent psychiatric disorder and positive thyroid autoantibodies had a poor response to Omalizumab therapy when compared to urticaria patients who were atopic and had high levels of eosinophils, basophils, and total IgE.