Dupilumab for CSU Therapy

In clinical practice, one of the greatest unmet needs in managing CSU lies with patients who have experienced treatment failure with omalizumab, a commonly used monoclonal antibody. Although dupilumab has recently gained approval for CSU, clinical trial data—particularly from the CUPID B study, which focused on omalizumab-refractory patients—showed limited benefit in that subgroup. As a result, for clinicians who are comfortable and experienced with omalizumab, dupilumab may not have a significant role, unless the patient also has comorbid conditions like nasal polyposis or atopic dermatitis, which are relatively uncommon.

Use of dupilumab in CSU tends to vary by specialty. In practices or specialties (such as dermatology) where omalizumab is not frequently prescribed, dupilumab may be used more often, especially if clinicians are more familiar with it from treating other conditions. However, in allergy clinics where omalizumab is a staple, dupilumab adoption for CSU is more limited. The speaker notes that although they frequently use dupilumab for other diseases, they currently have no patients with CSU on it in their own practice.

Beyond biologic failures, several other unmet needs remain for patients with CSU. These include the desire for effective oral therapies and for injectables with longer dosing intervals than current options. Because not all patients respond to the same treatments, a broader variety of therapeutic options is necessary. Expanding the treatment toolbox would help address variability in individual patient responses and better support personalized care in managing CSU.