From Avoidance to Action: Emerging Therapies for Management of Chronic Inducible Urticaria - Episode 12
Personalizing Advanced Therapy Selection for CIndU Subtypes
Comorbidities, age, reproductive plans, route of administration, and subtype-specific evidence all shape advanced therapy selection in CIndU, even as data for rarer subtypes remain limited.
"Personalizing Advanced Therapy Selection for CIndU Subtypes" takes up how the panel chooses among advanced therapies for the patient in front of them.
Dr. Cotter notes that all three advanced therapies require little monitoring, meaning check-ins rather than bloodwork. He asks how that translates into treatment selection.
Dr. Trotter starts with comorbidities. Omalizumab may suit patients with asthma or a history of angioedema. Dupilumab is a reasonable trial in atopic patients, though it is sometimes less successful. With the new approval, remibrutinib may be the preferred route for symptomatic dermographism. She also weighs patients' perceptions of each medication. Sometimes she can dispel concerns by reviewing data and safety, and sometimes she cannot. Method of administration is another piece of the puzzle.
Dr. Finklea adds age, since approved age ranges differ across the three agents, with remibrutinib approved for adults 18 and older. She also considers the likelihood of pregnancy or lactation, alongside comorbidities and needle phobia. Omalizumab has the most pregnancy safety data, and dupilumab has a pregnancy registry with some supporting data. With remibrutinib, the current recommendation is to avoid use in women who may become pregnant. Dr. Cotter emphasizes this point, because many patients with CSU are women of childbearing age.
He then asks Dr. Trotter how she chooses therapy for specific subtypes, such as delayed pressure, solar, heat, or exercise-induced urticaria. She relies on available data, including new RemIND data and off-label cold urticaria evidence. She then layers in patient factors and the impact on quality of life.
Dr. Cotter wonders whether success across three subtypes might extend to all of them, while acknowledging diseases differ. Dr. Finklea responds that data are lacking but patients exist and are eager for trials. She notes that many have overlapping CSU or several CIndU subtypes, calling this one of the fastest-evolving areas in dermatology.
In "Biomarkers and Early Intervention: Can Treatment Timing Change CIndU’s Course?" the panel talks about availability of biomarkers and importance of early intervention in CIndU.
