The clinical response to omalizumab in chronic spontaneous urticaria patients is linked to and predicted by IgE levels and their change
The clinical response to omalizumab in chronic spontaneous urticaria patients is linked to and predicted by IgE levels and their change
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DOI：
10.1111/all.13345
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发表时间：
2018-03-01
期刊：
影响因子：
12.4
通讯作者：
Maurer, M.
中科院分区：
文献类型：
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作者：
Ertas, R.;Ozyurt, K.;Maurer, M.
背景奥马珠单抗是治疗慢性自发性荨麻疹（CSU）的一种有效且耐受性良好的药物。反应的标志物和预测因子在很大程度上是未知的，但需要优化omalizumab治疗。奥马珠单抗靶向IgE，IgE水平可能与治疗效果相关。我们评估了CSU患者对奥马珠单抗治疗的应答率是否与他们的基线IgE水平、奥马珠单抗治疗后的IgE水平以及治疗中IgE和基线IgE水平的比率有关。或完全缓解，通过使用荨麻疹活动评分、医生和患者视觉模拟评分和治疗有效性评分进行评估。在omalizumab治疗前（bIgE）和治疗后4周（w 4 IgE）测量总IgE水平。（17.9，17.0-55.0 IU/mL）高于部分应答者（82.0，46.2-126.5 IU/mL，P = .008）和完全应答者（73.7，19.45-153.8 IU/mL，P = .032）。与部分和完全应答者相比，无应答者的w 4 IgE水平和w 4 IgE/bIgE水平比值也较低（P < .001）。对omalizumab无应答的最佳预测指标是患者的w 4 IgE/bIgE比值，显著优于bIgE水平（P = 0.016）.ConclusionsIn CSU，总IgE水平及其变化可预测omalizumab治疗应答。治疗前和治疗后IgE水平及其比值的评估可能有助于改善需要奥马珠单抗治疗的患者的CSU管理。
BackgroundOmalizumab is an effective and well-tolerated treatment for chronic spontaneous urticaria (CSU). Markers and predictors of response are largely unknown, but needed to optimize omalizumab treatment. Omalizumab targets IgE, and IgE levels may be linked to the effects of treatment. We evaluated whether response rates to treatment with omalizumab in patients with CSU are linked to their baseline IgE levels, their IgE levels after omalizumab treatment, and the ratio of on treatment IgE and baseline IgE levels.MethodsChronic spontaneous urticaria (CSU) patients (n = 113) were treated with omalizumab 300 mg/4 weeks for 12 weeks, when their treatment responses, that is, no, partial, or complete response, were assessed by use of the urticaria activity score, physician and patient visual analog scale, and treatment effectiveness score. Total IgE levels were measured before treatment (bIgE) with omalizumab and 4 weeks thereafter (w4IgE).ResultsNonresponders to omalizumab had significantly lower bIgE levels (17.9, 17.0-55.0 IU/mL) than partial responders (82.0, 46.2-126.5 IU/mL, P = .008) and complete responders (73.7, 19.45-153.8 IU/mL, P = .032). Nonresponders also had lower w4IgE levels and lower ratios of w4IgE/bIgE levels than partial and complete responders (P < .001). Nonresponse to omalizumab was best predicted by patients' w4IgE/bIgE ratios, significantly better than by bIgE levels (P = .016).ConclusionsIn CSU, total IgE levels and their change predict the response to treatment with omalizumab. The assessment of pre- and post-treatment IgE levels and their ratio may help to improve the management of CSU in patients who require omalizumab treatment.