TY - JOUR
T1 - Biologics for the Use in Chronic Spontaneous Urticaria
T2 - When and Which
AU - Maurer, Marcus
AU - Khan, David A.
AU - Elieh Ali Komi, Daniel
AU - Kaplan, Allen P.
N1 - Funding Information:
Conflicts of interest: M. Maurer reports grants and personal fees from Allakos, ArgenX, CSL Behring, FAES, Genentech, GIINNOVATION, Menarini, Moxie, Novartis, Sanofi/Regeneron, UCB, and Uriach; grants from Amgen, AstraZeneca, Innate Pharma, Kyowa Kirin, Leo Pharma, Lilly, Roche, and Centogene; and personal fees from Aralez, Celldex, and Third HarmonicBio, outside the submitted work. D. A. Khan reports personal fees from Genentech, outside the submitted work. The rest of the authors declare that they have no relevant conflicts of interest. No funding was received for this work.
Publisher Copyright:
© 2020 American Academy of Allergy, Asthma & Immunology
PY - 2021/3
Y1 - 2021/3
N2 - Guidelines for the treatment of chronic spontaneous urticaria (CSU) recommend the use of the IgE-targeted biologic omalizumab in patients with antihistamine-refractory disease. The rationale for this is supported by the key role of IgE and its high-affinity receptor, FcεRI, in the degranulation of skin mast cells that drives the development of the signs and symptoms of CSU, itchy wheals, and angioedema. Here, we review the current understanding of the pathogenesis of CSU and its autoimmune endotypes. We describe the mechanisms of action of omalizumab, the only biologic currently approved for CSU, its efficacy and ways to improve it, biomarkers for treatment response, and strategies for its discontinuation. We provide information on the effects of the off-label use, in CSU, of biologics licensed for the treatment of other diseases, including dupilumab, benralizumab, mepolizumab, reslizumab, and secukinumab. Finally, we discuss targets for novel biologics and where we stand with their clinical development. These include IgE/ligelizumab, IgE/GI-310, thymic stromal lymphopoietin/tezepelumab, C5a receptor/avdoralimab, sialic acid–binding Ig-like lectin 8/lirentelimab, CD200R/LY3454738, and KIT/CDX-0159. Our aim is to provide updated information and guidance on the use of biologics in the treatment of patients with CSU, now and in the near future.
AB - Guidelines for the treatment of chronic spontaneous urticaria (CSU) recommend the use of the IgE-targeted biologic omalizumab in patients with antihistamine-refractory disease. The rationale for this is supported by the key role of IgE and its high-affinity receptor, FcεRI, in the degranulation of skin mast cells that drives the development of the signs and symptoms of CSU, itchy wheals, and angioedema. Here, we review the current understanding of the pathogenesis of CSU and its autoimmune endotypes. We describe the mechanisms of action of omalizumab, the only biologic currently approved for CSU, its efficacy and ways to improve it, biomarkers for treatment response, and strategies for its discontinuation. We provide information on the effects of the off-label use, in CSU, of biologics licensed for the treatment of other diseases, including dupilumab, benralizumab, mepolizumab, reslizumab, and secukinumab. Finally, we discuss targets for novel biologics and where we stand with their clinical development. These include IgE/ligelizumab, IgE/GI-310, thymic stromal lymphopoietin/tezepelumab, C5a receptor/avdoralimab, sialic acid–binding Ig-like lectin 8/lirentelimab, CD200R/LY3454738, and KIT/CDX-0159. Our aim is to provide updated information and guidance on the use of biologics in the treatment of patients with CSU, now and in the near future.
KW - Angioedema
KW - Anti-IgE receptor
KW - Antihistamine
KW - Basophils
KW - Chronic spontaneous urticaria
KW - Eosinophils
KW - Mast cells
KW - Novel biologics
KW - Omalizumab
UR - http://www.scopus.com/inward/record.url?scp=85101652871&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101652871&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2020.11.043
DO - 10.1016/j.jaip.2020.11.043
M3 - Article
C2 - 33685605
AN - SCOPUS:85101652871
VL - 9
SP - 1067
EP - 1078
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
SN - 2213-2198
IS - 3
ER -