Considerations for Treatment Selection in CSU, With Jason Hawkes, MD, MS

Jason Hawkes, MD, MS, a board-certified dermatologist and associate professor of Dermatology at the University of California Davis, highlights how access, affordability, and insurance coverage are primary determinants when selecting therapies for chronic spontaneous urticaria. He underscores that even the most clinically desirable medication can be rendered inaccessible by practical cost or availability constraints. This reality underscores the need for shared decision-making and for clinicians to work closely with patients and insurers to ensure access to appropriate therapies.

In discussing patient preference, Hawkes notes the significance of mode of administration—some patients prefer the convenience of oral medications, such as antihistamines or remibrutinib, while others may find sustained injections more acceptable. The emergence of biologic therapies, including dupilumab and omalizumab, provides alternatives that may be administered less frequently, offering additional flexibility and speed of action, which can influence patient adherence and satisfaction.

Hawkes also considers the benefits of multi-indication therapies, citing dupilumab’s use across several type 2 inflammatory conditions, which may be advantageous for CSU patients with comorbidities. Ultimately, treatment selection is a nuanced process that involves balancing efficacy, safety, patient preference, and real-world factors such as coverage and cost.