Biomarkers and Early Intervention: Can Treatment Timing Change CIndU’s Course?

In “Biomarkers and Early Intervention: Can Treatment Timing Change CIndU’s Course?” the panel looks past today’s therapies toward precision medicine and disease modification.

Dr. Trotter asks Dr. Finklea where research stands on biomarkers that could predict treatment response in CSU and CIndU. She wonders whether the field is moving toward more precise, personalized care. Dr. Finklea explains that no verifiable biomarkers currently exist for CIndU. Research in CSU is further along, but several candidate markers remain impractical for routine use. Basophil activation tests, for example, are too costly for most patients.

She adds that some findings make biological sense. Low blood basophil counts, for instance, likely reflect basophils migrating into the skin. Other associations, such as elevated D-dimer, are less intuitive. She applauds researchers for pursuing these leads. She expects both the list of biomarkers and the field’s understanding of them to grow. For now, though, she knows of no verifiable biomarker for CIndU.

Dr. Cotter then poses a practical scenario: a patient seen tomorrow with a new diagnosis of CSU or CIndU. Leaving without treatment would hardly be empathetic, given the burden on quality of life and mental health. But does delaying treatment carry risk from a disease modification standpoint? Dr. Finklea agrees that clinicians should achieve control quickly. She notes that early intervention has shown disease-modifying potential in hidradenitis suppurativa, psoriasis, and the atopic march. Early treatment of urticaria might similarly help induce remission by dampening or retraining immune cells.

Dr. Trotter says she would delay care only if a patient were unwilling. She uses emerging data on early treatment to motivate hesitant patients. She describes treatment as a reboot that interrupts a self-perpetuating immune cycle. Dr. Cotter agrees. He tells patients the disease can become hardwired and ingrained when left untreated.

Our final episode, "Closing the Care Gap for Antihistamine-Refractory CIndU," turns to why refractory patients remain undertreated and what dermatologists can change tomorrow.