CME Satellite Symposium: Tips and Tricks to Advancing Chronic Spontaneous Urticaria Care

Marc Serota, MD, and Michelle Tarbox, MD, led an in-depth session on the evolving management of chronic spontaneous urticaria (CSU), emphasizing diagnostic precision, disease activity assessment, and the integration of novel biologic and small-molecule therapies into clinical practice.

The duo began by outlining the classification of urticaria based on duration and cauases, differentiating between inducible and spontaneous forms, and underscoring that nearly 80% of chronic cases are spontaneous. They discussed current international guidelines recommending a stepwise approach: beginning with avoidance of triggers and second-generation H1 antihistamines, escalating doses up to fourfold if needed, and advancing to omalizumab or cyclosporine in refractory cases. The speakers emphasized disease monitoring using the Urticaria Activity Score (UAS7) and the Urticaria Control Test (UCT), where a UAS7 ≤6 or UCT ≥12 indicates well-controlled disease, reinforcing the shift toward objective, quantifiable disease assessment to step-up or step-down management. 

The session transitioned to therapeutic developments poised to transform CSU care. The team reviewed recent evidence supporting omalizumab, citing meta-analyses of 67 real-world studies confirming its strong efficacy and safety. Next, they presented emerging phase 3 data from the LIBERTY-CSU CUPID trials demonstrating significant reductions in itch severity and urticaria activity with dupilumab compared to placebo, achieving complete response rates in up to 30% of patients. They also highlighted the REMIX-1 and REMIX-2 studies evaluating the BTK inhibitor remibrutinib, which achieved meaningful UAS7 improvements by week 24 with comparable safety to placebo. The discussion concluded with an outlook on integrating these biologic and targeted therapies into personalized treatment algorithms, aiming to achieve faster disease control and improved quality of life for patients with CSU.