The American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting took place this year from February 25-28, 2022. During the meeting, stakeholders gathered to discuss new technologies, healthcare reform, research, and management in the fields of allergy, asthma, and immunology. According to Healio, one presentation (Abstract L01) centered around data from the Phase 3 LIBERTY-CSU CUPID Study A. This trial evaluated dupilumab for individuals with chronic spontaneous urticaria, or chronic idiopathic urticaria, who are resistant to treatment with H1 antihistamines. Altogether, researchers found that dupilumab reduced related symptoms and improved quality of life (QOL). 

Evaluating Dupilumab: The LIBERTY-CSU CUPID Study A Trial

Typically, H1 antihistamines – such as desloratadine, cetirizine, and fexofenadine – are used to treat patients with chronic idiopathic urticaria. When symptoms worsen, doctors typically recommend higher treatment doses. But for patients whose condition is refractory to these treatments, symptoms can be debilitating and thus reduce QOL.

Dupilumab is a humanized monoclonal antibody which inhibits IL-4 and IL-13 signaling. It is currently approved for use under the brand name DUPIXENT for atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis. Within this Phase 3 trial, researchers sought to understand the impact of dupilumab on chronic idiopathic urticaria. In particular, researchers wanted to determine the treatment’s safety, efficacy, and tolerability in those aged 6+ whose symptoms had not been resolved using H1 antihistamines. 

Over a 24-week period, patients received either dupilumab (added onto their antihistamine doses) or a placebo. Those weighing 132 pounds or less received 200mg of dupilumab, while those weighing more received 300mg. Findings from the study include:

• Both groups had similar itch severity scores and urticaria activity scores at the onset of the study. Following treatment, dupilumab significantly reduced itching compared to the placebo.
• Additionally, dupilumab helped reduce inflammation and other activity associated with chronic spontaneous urticaria. While those receiving the placebo also saw some reduction, symptom reduction was strongest in those taking dupilumab.
• Interestingly, more adverse reactions occurred in the placebo group than the dupilumab group. While dupilumab was relatively safe and well-tolerated, some patients experienced injection site reactions. 

About Chronic Idiopathic Urticaria (CIU)

Chronic idiopathic urticaria (CIU), or chronic spontaneous urticaria, is an unpredictable form of chronic hives. As the name suggests (idiopathic), there is no known cause for these hives. However, CIU may be triggered by infection, changes in temperature, stress, alcohol consumption, pressure on the skin, certain medications, or even insect bites. Hives are considered chronic when they appear on and off for 6 weeks or more. In some cases, these hives may last for months or even years. Females are 2x more likely to have chronic idiopathic urticaria than males. Symptoms and characteristics include:

• Moderate-to-severe itching
• Pain and burning caused by swelling
• Clusters of red or white welts (which vary in shape and size) that may appear anywhere on the body
• Headache and fatigue
• Joint pain and inflammation
• Heart palpitations
• Localized angioedema, often affecting the hands, feet, face, or genitalia