Optimizing Treatment Pathways in Chronic Spontaneous Urticaria - Episode 4
Escalating Therapy in Chronic Spontaneous Urticaria Management
Exploration of using tools such as UAS7 and DLQI to quantify disease severity, predict poor response, and guide timely therapy escalation.
This Insights series focuses on optimizing management for chronic spontaneous urticaria (CSU) through evidence-based and individualized care. April Armstrong, MD, MPH, begins by reviewing the latest international CSU guidelines, highlighting diagnostic distinctions between spontaneous, inducible, and secondary forms. She emphasizes the importance of structured disease assessment using standardized tools such as the Urticaria Activity Score 7-day and the Dermatology Life Quality Index to track response and inform timely escalation. The discussion outlines key predictors of poor response to antihistamines and the critical need for proactive, rather than reactive, treatment decisions to prevent chronic disease burden.
The program then explores therapeutic innovation, particularly the rise of oral Bruton tyrosine kinase inhibitors such as remibrutinib, which demonstrated rapid, durable symptom control and sustained remission through 52 weeks in the REMIX-1 and REMIX-2 trials. Armstrong examines how these findings may redefine long-term management goals and reshape patient expectations around control vs remission. She provides guidance on communicating treatment transitions, addressing concerns about injectables vs oral therapies, and balancing efficacy with adherence and accessibility—particularly as small molecule therapies expand options beyond traditional biologics such as omalizumab.
Finally, the conversation looks ahead to future directions in CSU care, envisioning a shift from rigid stepwise algorithms to mechanism-based personalization. Armstrong discusses emerging biomarkers that could predict treatment response as well as how dermatologists and allergists may increasingly share roles in CSU management as therapeutic categories converge. She closes by highlighting the promise of new oral targeted therapies and the importance of integrating patient-reported outcomes and shared decision-making to achieve lasting control and improved quality of life.
