Chronic Spontaneous Urticaria Learning Zone
Transcript: Omalizumab in CSU
Marcus Maurer, MD, and Petra Staubach-Renz, MD
All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speakers and is not adjusted by Medthority.
- Oh, good question here from Hassan. - A patient with CSU and severe asthma, IgE 900, eosinophil count is 700. Go on, Hassan. What's your question? - Maybe he wants to ask the right medication therapy. - Ah, do you think omalizumab will work? I think that's the second half to his question. Yes, I do. Yes, I do think that it will work. Look, omalizumab is an asthma drug, omalizumab is a urticaria drug and have seen it work on both diseases in patients who have both. - But I think yes, omalizumab will work. And we are working together with our pulmonologists. We have a lot of patients together with them, and we know that it works. So we, back again, Marcus.
- Back again. Yes, and I agree with you. It will work. And I'm, you know, I'm always happy when I see IgE in the hundreds, because this is one of the markers that points me to autoallergic urticaria and autoallergic urticaria patients, they tend to respond fast and complete. Now, you may argue that this patient's IgE is high because of the asthma rather than the urticaria. But hey, who cares? This is the standard of care for patients who fail antihistamines. So let's do it and let's see if this patient will respond My prediction is you will have good impact for both. - But Marcus, one question, what the patients are, or if they are on treatment with antihistamine, they do not work. And then add on omalizumab.
Do we have a biomarker which says omalizumab works during the first weeks? Or you have to tell the patients it may work, you are at home, you have no more symptoms, but it may last several months. When do I have to stop and so on. And I would like to know, does it work fast and when does it take time? - Yeah. Look, I wish I had that. All I can say is indirectly yes. You know, you'll see me smile as a patient when I see that your IgE is high, that you have a comorbid allergy. No autoimmunity, no angioedema, because those are markers of autoimmune, chronic spontaneous . Then I'm fairly confident that within the first month of your first injection, you will be fine.
Now, if you are a patient, Petra, who tells me, "Oh, I also have Hashimoto. I have lots of angioedema. It's been going on for a long while and you know, and plus I have low IgE and I have elevated IgG and anti-TPO." And then I go, "Oh, oh, oh, oh, oh." I will still try. No, but I will be a lot less enthusiastic about being your hero during the first month of treatment. I will tell you that this is the best thing that we can do. This will take time. We need patience. Do tell me if it's too hard to endure. And then we have to think of other solutions. So it, you know, it's not a hard predictor. It's more of a expectation management tool. And I do recommend that all of you look at IgE and anti-TPO. And if the IgE is low and the IgG is high, please do suspect autoimmune, chronic, spontaneous urticaria and keep an extra eye on this patient when you start your omalizumab treatment, it can take six months before you really see them respond. Wow. Lots of questions. I shouldn't be talking so long. - But it is important to tell the patient it works, but stay, and of course we have to talk to them and then it's okay.
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