Multinational Drug Survival Study of Omalizumab in Patients With Chronic Urticaria and Potential Predictors for Discontinuation.

Importance: Treating patients with chronic urticaria using omalizumab has been shown to be safe and effective in randomized clinical trials. Multinational studies on long-term omalizumab performance in chronic urticaria in clinical practice settings are lacking, especially on drug survival. Drug survival, which refers to the length of time that patients are treated with a specific drug, is a comprehensive outcome covering effectiveness, safety, and patient and physician preferences. Furthermore, little is known about the reasons and potential predictors for omalizumab discontinuation. Objective: To investigate omalizumab drug survival as well as reasons and potential predictors for discontinuation in a large, diverse population. Design, Setting, and Participants: This international multicenter cohort study was conducted at 14 Urticaria Centers of Reference and Excellence in 10 countries, including all patients with chronic urticaria from these centers who were ever treated with omalizumab. Main Outcomes and Measures: Drug survival analysis was performed to assess time to discontinuation. Patient characteristics and treatment protocols were investigated by Cox regression analysis to identify potential predictors for omalizumab discontinuation. Results: In 2325 patients with chronic urticaria who started omalizumab between June 2009 and July 2022, the mean (SD) age of the cohort was 42 (6) years, and 1650 participants (71%) were female. Overall omalizumab survival rates decreased from 76% to 39% after 1 to 7 years, respectively (median survival time, 3.3 [95 % CI, 2.9-4.0] years), primarily due to discontinuation from well-controlled disease in 576 patients (65%). Ineffectiveness and adverse effects were reasons for discontinuation in a far smaller proportion of patients, totaling 164 patients (18%) and 31 patients (4%), respectively. Fast treatment response was associated with higher rates of omalizumab discontinuation due to well-controlled disease (hazard ratio, 1.45 [95% CI, 1.20-1.75]), and disease duration of more than 2 years was associated with lower rates of discontinuation due to well-controlled disease (HR, 0.81 [95% CI, 0.67-0.98]). Immunosuppressive cotreatment at the start of omalizumab and autoimmune disease was associated with a higher risk for discontinuation due to ineffectiveness (HR, 1.65 [95% CI, 1.12-2.42]). The presence of spontaneous wheals (HR, 0.62 [95% CI, 0.41-0.93]) and access to higher dosages (HR, 0.40 [95% CI, 0.27-0.58) were both associated with a lower risk for discontinuation of omalizumab due to ineffectiveness. Conclusion and Relevance: This multinational omalizumab drug survival cohort study demonstrated that treatment of chronic urticaria with omalizumab in a clinical setting is effective and safe, and well-controlled disease is the main reason for treatment discontinuation. These findings on omalizumab drug survival rates and reasons and potential predictors for discontinuation may guide patients and physicians in clinical decision-making and expectation management. These results may call for the identification of biomarkers for chronic urticaria remission in complete responders to omalizumab treatment.

Clinical Features and Outcomes of Acute versus Chronic Urticaria Triggered by COVID-19 Infection.

OBJECTIVE: Although acute urticaria (AU) and urticaria-like rash are commonly reported with COVID-19 infection, chronic spontaneous urticaria (CSU) triggered by COVID-19 is rare. The authors compared the features of COVID-19 infection-induced chronic CSU and AU to determine which patients' COVID-19 infection leads to CSU and possible indicators of chronicity. METHODS: The authors retrieved the charts of patients diagnosed with AU or CSU following COVID-19 at the Urticaria Centers of Reference and Excellence and compared patients in terms of demographic characteristics, length of time between infection and onset of urticaria, duration of urticaria, COVID-19 disease severity, laboratory test results, vaccination, and treatment status. RESULTS: A total of 92 patients were included in the study: 7 with CSU following COVID-19 and 85 with AU after COVID-19. The mean duration of urticaria for CSU and AU following COVID-19 was 13.0 ± 6.0 months and 7.1 ± 3.4 days, respectively. The average time between COVID-19 and the start of urticaria was longer in the CSU group (20.7 ± 3.9 days vs 4.5 ± 2.8 days, respectively; P = .000). No between-group differences were found for any other parameters. CONCLUSIONS: The onset of urticaria more than 2 weeks after COVID-19 infection may serve as an indicator for urticaria chronicity beyond 6 weeks and may help physicians predict the possible course of urticaria associated with COVID-19 infection. The relevance of basopenia and eosinopenia needs to be determined.

Investigation of systemic immune-inflammation index and systemic inflammation response index as an indicator of the anti-inflammatuary effect of isotretinoin in patients with acne vulgaris.

PURPOSE: Oral isotretinoin (ISO) can effect markers of inflammation in patients with acne vulgaris. Systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were described as novel inflammatory and prognostic biomarkers. The present study aimed to evaluate the effectiveness of SII, SIRI, and other inflammatory markers in patients with acne vulgaris who receive isotretinoin therapy. METHODS: One hundred fifty-six patients with moderate-to-severe acne vulgaris who received at least 3 months of ISO treatment (0.5-1 mg/kg/day) and 100 healthy individuals were enrolled in the study. The medical records and laboratory findings of the participants were reviewed retrospectively. Pre-treatment and post-treatment neutrophil, lymphocyte, monocyte, and platelet counts, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), SII, SIRI, total cholesterol, LDL cholesterol, triglyceride, HDL cholesterol, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were analysed. RESULTS: Before ISO treatment, patients with moderate-to-severe acne vulgaris had significantly higher platelet counts than healthy controls (p = 0.003). Serum total cholesterol, LDL, triglyceride, AST, and ALT increased significantly after isotretinoin treatment in patients with acne vulgaris (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.029, respectively). In the follow-up of patients using ISO, a significant increase was found in platelet levels (p < 0.001). However, neutrophil, NLR, SII, and SIRI were found significantly decrease after ISO treatment (p = 0.047, p = 0.038, p = 0.003, p = 0.001; respectively). Lymphocyte, monocyte, PLR, and MLR did not show any significant change after ISO treatment. CONCLUSION: SII and SIRI are better parameters as an indicator of the anti-inflammatory effect of isotretinoin than other inflammatory markers.

Investigation of intestinal microbiome in chronic spontaneous urticaria patients.

BACKGROUND: Chronic urticaria is a disorder characterized by itchy erythematous plaques with edema lasting 6 weeks or more. The prevalence is 1%, and two thirds of these cases are "chronic spontaneous urticaria (CSU)." Drugs, food, infections, and systemic diseases may be etiologic factors for CSU, although it may be idiopathic. OBJECTIVES: The aim of this study was to compare the diversity and distribution of the intestinal microbiome in CSU patients with that of healthy individuals. The hypothesis was to determine the probable association of intestinal microbiome with CSU. METHODS: This study was conducted in Sakarya University Training and Research Hospital, Department of Dermatology. In this study, 20 CSU patients and 10 healthy volunteers were included. Stool samples were collected from all participants. 16S RNA sequencing and bioinformatic analysis were performed after isolation of DNA isolation from all samples. RESULTS: Diversity in microorganisms, stool pH averages, Bristol scores, and the ratio of Firmicutes/Bacteroidetes were the significant changes between the two groups. LIMITATIONS: Due to high cost involved in microbiota studies, only a limited number of patients and volunteers participated. CONCLUSION: The alteration in the intestinal microbiota (dysbiosis) may be an essential factor for CSU development and may explain idiopathic cases.

Pyoderma Gangrenosum Associated with Sunitinib: A Case Report.

Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis that presents with painful, sterile ulcers. Drug-induced PG is a rare condition; propylthiouracil, granulocyte colony-stimulating factor, and sunitinib are drugs that have been implicated to date. This article presents a case of PG associated with sunitinib.

Single-center experience with potassium titanyl phosphate (KTP) laser for superficial cutaneous vascular lesions in face.

BACKGROUND AND OBJECTIVES: Superficial cutaneous vascular lesions (SCVLs) are quite common. Several types of lasers have been used to treat these lesions; however, there are no dedicated treatment guidelines and few studies in the literature addressed their treatment. AIMS: In this paper, we aimed to report our clinical experience with potassium titanyl phosphate (KTP) laser treatment on different types of facial SCVLs including telangiectasia, spider angioma, and erythema. METHODS: Data were retrospectively collected from 146 patients with SCVLs, who had been treated with the 532-nm wavelength laser at our outpatient dermatology clinic. Treatment responses were graded as four groups: clearance (> 75% improvement compared with the previous session), marked improvement (50-75%), partial improvement (25-50%), and no response (< 25%). RESULTS: The rate of clearance plus marked improvement (favorable outcome) was 66.1% for telangiectasia group, 93.5% for spider angioma group, and 26.7% for erythema group. Mean number of treatments was 2.9 ± 1.4 for telangiectasia group, 1.4 ± 0.8 for spider angioma group, and 2.9 ± 1.7 for facial erythema group. Only minimal adverse effects related to treatment procedure were detected in 5 out of 146 (3.4%) patients. CONCLUSIONS: Our results demonstrated that KTP laser might be a safe and effective laser modality for SCVLs, which may be associated with physiological problems due to cosmetic concerns.

Narrow band ultraviolet B for the treatment of generalized lichen planus.

OBJECTIVE: Although various treatment options have been used in the treatment of lichen planus (LP), it is still challenging to choose the most effective one. Scarce data are available in the literature examining efficacy of NB-UV in the treatment of LP. Thus, we aimed to evaluate efficacy of NB-UVB for LP. METHODS: Twenty-four patients with generalized LP who received NB-UVB treatments in between January 2011 and December 2014 were included in the study. Response types were classified into three groups which complete response refers to ≥90% reduction in the number of the lesions; partial response 51-89%; and no response ≤50%. RESULTS: Sixteen patients responded to the NB-UVB treatment [5 partial (20.8%) and 11 complete (45.8%) remissions], whereas 8 patients (33.3%) did not respond to the treatment. A number of sessions and accordingly cumulative dose of UVB were significantly higher in responded group than in non-responders. When we compared these two groups according to duration of the disease, there was no significant difference. CONCLUSIONS: Two-thirds of patients with generalized LP favorably responded to NB-UVB treatment without any remarkable adverse events. This significant response rate coupled with safety should prompt further clarification of the place of NB-UVB in generalized LP.