Table 1 Clinical outcomes and tolerability with cyclosporine for cohort of patients with omalizumab-refractory chronic urticaria
From: Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases
Patient #1 | Patient #2 | Patient #3 | Patient #4 | Patient #5 | |
|---|---|---|---|---|---|
Age | 24 | 35 | 41 | 39 | 58 |
Gender | Female | Male | Female | Male | Female |
Comorbidities | None | Vitiligo, chronic rhinitis | Hypertension, headaches, chronic rhinitis | Asthma, chronic rhinitis, hyperthyroidism | Asthma, chronic rhinitis, thyroid cancer (s/p thyroidectomy), hypertension |
BMI | 26 kg/m2 | 36 kg/m2 | 35 kg/m2 | 33 kg/m2 | 34 kg/m2 |
Urticaria type | Chronic spontaneous urticaria | Chronic spontaneous urticaria | Chronic spontaneous urticaria | Chronic inducible urticaria | Chronic spontaneous urticaria |
Urticaria Duration | 7 months | 12 months | 9 months | 18 months | 12 months |
Pertinent laboratory studies | ANA, RF, and cryoglobulin negative. Normal TSH. Anti-TPO and Anti-thyroglobulin antibodies negative | ANA negative. Normal TSH | Normal TSH | ANA negative. Anti-TPO and Anti-thyroglobulin antibodies negative | ANA negative. Anti-thyroglobulin antibodies negative |
Prior use of corticosteroids | Yes | No | Yes | No | Yes |
Omalizumab Dose | 300 mg every 4 weeks | 300 mg every 4 weeks | 300 mg every 4 weeks | 300 mg every 4 weeks | 300 mg every 4 weeks |
Omalizumab treatment duration | 20 weeks | 48 weeks | 12 weeks | 52 weeks | 12 weeks |
Cyclosporine Dose (milligram per kilogram per day) | 3 | 1 | 1 | 1; dose later increased to 3 | 1.25; dose later increased to 3 |
Cyclosporine dosage categorya | Low-Dose | Very Low-Dose | Very Low-Dose | Very Low-Dose (initially) low-dose was later used due to lack of clinical improvement | Very low-dose (initially) low-dose was later used during a recurrence when symptoms failed to respond to very low doses |
Cyclosporine treatment duration | 16 weeks | 16 weeks | 30 weeks | 44 weeks | 24 weeks |
Concomitant medicationsb | Cetirizine 20 mg twice daily, Ranitidine 150 mg twice daily | Fexofenadine 360 mg twice daily, Ranitidine 150 mg twice daily | Cetirizine 20 mg twice daily, Ranitidine 150 mg twice daily, Hydroxyzine 25 mg daily every evening, Montelukast 10 mg daily | Cetirizine 10 mg twice daily, Fexofenadine 180 mg daily, Hydroxyzine 25 mg daily every evening, Ranitidine 150 mg twice daily, Montelukast 10 mg daily | Cetirizine 20 mg twice daily, Ranitidine 150 mg twice daily, Montelukast 10 mg daily |
Clinical Response to cyclosporinec | Complete response | Complete response | Complete response | Near-complete improvement of cholinergic urticaria, moderate improvement of pressure-induced urticaria | Complete response |
Time to clinical improvement on cyclosporine therapy | 2 weeks | 1 week | 2 weeks | 24 weeks | 1 week |
Relapse (if remission had occurred) | No | No | Yes | N/A | Yes |
Adverse effects of cyclosporine | None | None | During second course of cyclosporine developed hypertension (did not prompt drug discontinuation) | Hypertension, hyperglycemia, hematuria, elevated uric acid (prompting cessation)d | During second course of cyclosporine developed elevated creatinine (peak 1.24 from baseline 1.00), prompting cessatione |