Transcript
Expert insights: CSU treatment escalation
Gülseren Tuncay outlines treatment escalation guidance for CSU and discusses how forthcoming updates will expand options, including the addition of two new biologics and a stronger focus on patient-specific factors. View transcript.
Gülseren Tuncay, MD
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Studies have not demonstrated the superiority of different antihistamine preparation, over one or another. Therefore, if a patient tolerates an antihistamine but does not respond to the standard dose, I would recommend increasing to a higher dose. If there's still no response at a higher dose, I would suggest initiating standard dose omalizumab as a second line treatment according to the current guidelines, two to four weeks is sufficient to evaluate the response to antihistamine.
However, in the yet to be published urticaria guidelines summarised by Professor Emek Kocatürk at EAACI in Glasgow, the use of dupilumab and remibrutinib as alternatives to omalizumab was also recommended. We now have new treatment options, of course, access to these medications, and their coverage by insurance varies by countries. Nevertheless, we can now say that in a second line setting we have other biologic options besides omalizumab or biosimilar. The road and frequency of administration are important factors in terms of patients' quality of life.
Whether the medication is in the tablet form or requires injection, as well as the presence of comorbid conditions such as allergic asthma, chronic rhinitis as it is with nasal polyps are key factors that can influence our choice of treatment.
Gülseren Tuncay, MD
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