Emerging treatments for chronic urticaria.

Area of Science:

• Immunology
• Dermatology
• Pharmacology

Background:

• Chronic urticaria (CU), encompassing chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CINDU), presents a significant global health challenge due to its persistence and refractory nature.
• A substantial proportion of patients, at least 20%, do not achieve sufficient symptom control with standard treatments like H1-antihistamines and omalizumab.

Purpose of the Study:

• To review the current pipeline of novel therapeutics in clinical development for chronic urticaria.
• To assess the potential of emerging biologics and small molecules in addressing unmet needs in CU management.

Main Methods:

• A comprehensive literature search was conducted using PubMed, ClinicalTrials.gov, and manufacturer and congress websites.
• The review focused on identifying and analyzing biologics (anti-IgE, anti-cytokine, anti-cytokine receptor) and small molecules in various stages of clinical development for CU.

Main Results:

• The pipeline for CU therapeutics is robust, featuring omalizumab biosimilars and promising agents like ligelizumab targeting the anti-IgE pathway.
• Development is advancing for selective oral BTK inhibitors, with remibrutinib in Phase 3, and several anti-cytokine/anti-cytokine receptor biologics are under investigation, though some are in earlier phases.

Conclusions:

• The emerging therapeutic pipeline for chronic urticaria holds significant promise for improved patient outcomes.
• Further research into these novel agents will deepen our understanding of CU's pathomechanisms and potentially lead to more targeted and effective treatment options.