Dupilumab in Chronic Spontaneous Urticaria

Treatment with Dupilumab has been shown to reduce clinically significant exacerbations and to improve skin symptom control as well as quality of life in moderate to severe atopic dermatitis patients and in moderate to severe asthma patients. It has been approval by European Medicines Agency (EMA) for the treatment of atopic dermatitis patients in September 2017. Dupilumab is a novel monoclonal antibody that inhibits interleukin‐4 (IL‐4) and interleukin‐13 (IL‐13) signaling and was previously found to be effective in atopic dermatitis and asthma. Considering that CSU and atopic diseases share many common features (e.g. key pathogenic role of mast cells and (Immunoglobulin E) IgE, itch is a dominant symptom, Th2 dominance), it is reasonable to expect that Dupilumab is beneficial in CSU. These results suggest that Dupilumab may provide an effective treatment option for patients with insufficient treatment responses to H1‐antihistamines exhibiting wheal and flare type skin reactions. The gold standard treatment of CSU consists of administration of antihistamines. In more than 50% of the patients, symptoms persist with standard dosing of antihistamines. In antihistamine‐refractory patients with chronic spontaneous urticaria, the currently only licensed treatment is omalizumab, a monoclonal anti‐IgE antibody. In 2014, omalizumab has been licensed for add‐on therapy in CSU patients who still have symptoms despite standard‐dosed antihistamine treatment. There is, however, still a great medical need for additional treatment options, as 20‐40% of patients are still without effective therapy. These patients have no other licensed treatment option and can only be treated off‐label with therapeutics with several known safety risks such as Cyclosporine A. Dupilumab has excellent potential to provide symptom control in CSU. This study will provide additional valuable insights into the therapeutic potential of Dupilumab in improving quality of life in these patients, in addition to managing CSU symptoms.