Successful Treatment of Refractory Chronic Spontaneous Urticaria with Stapokibart After Omalizumab Failure: A Case...

Chronic spontaneous urticaria (CSU) is a mast cell-mediated skin disease characterized by wheals and/or angioedema. Some patients remain symptomatic despite standard-of-care antihistamines or omalizumab. We report a 44-year-old female with refractory CSU with a history of recurrent widespread erythema and wheals with pruritus for over one year. She was failed to achieve adequate disease control with oral antihistamines and 5 doses of omalizumab 300 mg. She was subsequently treated with anti-IL-4Rα antibody stapokibart 300 mg (loading dose 600 mg) for 35 weeks, with an extended-interval dosing regimen (every 2 week for 9 doses, every 3 weeks for 3 doses, and every 6 weeks for 2 doses). Rapid symptom control was observed by week 2 (Urticaria Activity Score [UAS7] of 0 and Urticaria Control Test [UCT] score of 12), with complete disease control achieved by week 22 (UAS7 of 0 and UCT score of 16). No relapse occurred during 3-month follow-up period.