Learnings from real-life experience of using omalizumab for chronic urticaria in Latin America

World Allergy Organ J. 2019 Feb 23;12(2):100011. doi: 10.1016/j.waojou.2019.100011. eCollection 2019.


Background: Updated urticaria guidelines recommend that patients should be assessed for disease activity, severity, control, and quality of life at baseline and follow up. Regarding treatment, guidelines consider second generation antihistamines as the cornerstone in therapy for chronic urticaria (CU), while other drugs, such as omalizumab, are conceived as second-line alternatives. In regards to omalizumab, despite advances in the management of CU, there are still open questions about timing, dosing, and objective measures for clinical response. This study was designed to portray the use of patient-reported outcomes (PROs) in chronic urticaria management, as well as the effectiveness and treatment patterns of omalizumab in CU, as seen in a real-life setting in Latin America.

Methods: This is a retrospective observational study, involving 72 Latin American patients with chronic urticaria treated with omalizumab. Patient reported outcomes and treatment patterns, response, quality of life improvement and discontinuation were analyzed.

Results: From the 72 patients, 91.7% (n = 66) were assessed through PROs, where urticaria control test (UCT) was the most used (79.2%; n = 57). Overall, 80.0% (n = 44) responded to omalizumab at some point of the treatment. Omalizumab 300 mg was associated with earlier response compared to lower doses. Regardless of dosage, most patients assessed with CU-Q2oL improved quality of life (80.8%; n = 21). With respect to omalizumab discontinuation, 20.8% (n = 15) patients interrupted omalizumab before the 3rd month of treatment (p = .000).

Conclusions: The present study highlights how the use of PROs and omalizumab in Latin America differ from guidelines' recommendations and clinical trials. Even though most patients were initiated under omalizumab 300 mg, most of them finished with lower doses. Regardless of dosage, most patients responded to omalizumab and improved quality of life at some point during treatment. However, such features were seen earlier with omalizumab 300 mg. Regarding treatment discontinuation, one-fifth of patients interrupted omalizumab before the third month.

Keywords: CU, chronic urticaria; CU-Q2oL, chronic urticaria quality of life questionnaire; Chronic spontaneous urticaria; EAACI/GA2LEN/EDF/WAO, European Academy of Allergology and Clinical Immunology; Global Allergy and Asthma European Network, European Dermatology Forum and World Allergy Organization; LA, Latin America; Latin America; MCID, minimal clinical important difference; Omalizumab; PRO, patient-reported outcomes; Patient-reported outcomes; Quality of life; SD, standard deviation; UAS7, urticaria activity score 7; UCT, urticaria control test.