■慢性自发性荨麻疹(CSU)是一种相对常见的免疫介导疾病,如今可以有效治疗。然而,对于某些患者,按照当前的治疗建议无法实现缓解,定义为抗性CSU(r-CSU)。治疗r-CSU很有挑战性,and,目前,没有建议的干预措施。在这项现实生活中的研究中,我们描述了使用抗IgE抗体(奥马珠单抗)联合免疫抑制剂的“强化方案”对18例r-CSU患者的成功治疗。我们定义了r-CSU表型,并将其与奥马珠单抗反应性CSU(Or-CSU)表型进行了比较。
■72例CSU患者的临床和血清学数据(即,回顾性收集并分析了18个r-CSU和54个年龄和性别匹配的Or-CSU)。所有患者均诊断为CSU≥6个月,并于2013-2018年在舍巴医疗中心接受治疗。
■289例CSU患者,18(6%)被诊断为r-CSU,并接受“强化方案”治疗,包括奥马珠单抗和环孢素A(16p),甲氨蝶呤(1p),和硫唑嘌呤(1p)。其中,14/18(78%)完全缓解,2/18(11%)部分缓解,和2/18(11%)没有缓解。在随访期间,没有记录到严重的不良事件。r-CSU患者接受了较高剂量的抗组胺药(p<0.0001)和奥马珠单抗(425±58mg/月vs.283±86mg/月;p<0.0001)与Or-CSU相比。r-CSU表型与伴随的自身免疫(p=0.0005)和在开始治疗之前较低水平的IgE(p=0.027)有关。
■r-CSU可能是一种以严重疾病为特征的独特CSU表型,伴随自身免疫,和较低的基线IgE水平(低“自身过敏”)。发现奥马珠单抗和免疫抑制剂的“强化方案”对r-CSU有效且安全。需要进一步的更大的研究来验证这些结果。
UNASSIGNED: Chronic Spontaneous Urticaria (CSU) is a relatively common immune mediated disease that can be effectively treated nowadays. Nevertheless, for some patients remission cannot be achieved following current treatment recommendations, defined as resistant CSU (r-CSU). Treating r-CSU is challenging, and, currently, there are no recommended interventions. In this real-life study we describe successful therapy of 18 r-CSU patients using an \"intensified protocol\" of anti-IgE-antibody (omalizumab) concomitantly with an immunosuppressant. We defined the r-CSU phenotype and compared it to omalizumab-responsive CSU (Or-CSU) phenotype.
UNASSIGNED: Clinical and serological data of 72 CSU patients (ie, 18 r-CSU and 54 age and sex matched Or-CSU) were retrospectively collected and analyzed. All patients were diagnosed with CSU for ≥6 months and treated at the Sheba Medical Center during 2013-2018.
UNASSIGNED: Of 289 CSU patients, 18 (6%) were diagnosed with r-CSU and treated with the \"intensified protocol\" including omalizumab and cyclosporine-A (16p), methotrexate (1p), and azathioprine (1p). Of which, 14/18 (78%) achieved complete remission, 2/18 (11%) partial remission, and 2/18 (11%) no remission. During follow-up no serious adverse events were documented. r-CSU patients received higher doses of antihistamine (p < 0.0001) and omalizumab (425 ± 58 mg/month vs. 283 ± 86 mg/month; p < 0.0001) compared to Or-CSU. The r-CSU phenotype was linked with concomitant autoimmunity (p = 0.0005) and a lower level of IgE prior to initiation of therapy (p = 0.027).
UNASSIGNED: r-CSU may be a distinct CSU phenotype characterized by severe disease, concomitant autoimmunity, and lower baseline-IgE levels (low \"autoallergy\"). An \"intensified protocol\" with omalizumab and an immunosuppressive agent was found to be efficacious and safe for r-CSU. Further larger studies are required to verify these results.