Ep. 82: The Future of Chronic Spontaneous Urticaria Treatments
Part of the series: Allergy, Asthma & Immunology Innovations Podcast
This podcast was made in partnership with Allergy & Asthma Network. We thank Novartis for sponsoring this podcast.
LISTEN TO EPISODE 82:
There’s never been a better time to be a CSU patient, with cutting-edge therapies and revolutionary treatments just around the corner. As research accelerates, new and promising options (Dupilumab, Remibrutinib, and Barzolvolimab) that could significantly improve the quality of life for those living with Chronic Spontaneous Urticaria are coming to market.
In this episode, Dr. Matthew Zirwas joins us to discuss the latest advancements in treating CSU, offering invaluable insights into both current and emerging treatment options. With his extensive experience and patient-centred approach, Dr. Zirwas breaks down the complexities of CSU and highlights how these new therapies can make a real difference.
What we cover in our Episode about emerging chronic spontaneous urticaria treatments:
How Dr. Zirwas explains CSU to his patients: Discover the patient-friendly explanations that help demystify CSU and empower patients to learn more about their disease.
When to start with a biologic: Learn about the decision-making process for initiating biologic therapies like Xolair (omalizumab) and when they are most appropriate.
The new medications coming to market: Get an overview of the latest advancements, including:
Dupixent (dupilumab): A biologic administered via injection that targets key pathways in the inflammatory response.
Remibrutinib: A BTK (Bruton tyrosine kinase) inhibitor available as a pill that blocks a crucial enzyme in mast cell activation.
Barzolvolimab: A promising biologic that targets the C KIT receptor on mast cells to reduce their number.
Shared decision-making with these medications: Explore strategies for choosing the most appropriate treatment in a rapidly evolving therapeutic landscape.
Research into the underlying cause of CSU: What’s happening on the research front to uncover the root causes of CSU.
About Our Guest
Dr. Matthew Zirwas, MD, is a board-certified dermatologist and a nationally recognized expert in allergy patch testing, psoriasis, and eczema. He founded the Bexley Dermatology Research Clinic, offering patients access to the latest treatment options before they are widely available. Dr. Zirwas also serves as a dermatologic advisor for several companies, including ALL Laundry Detergent and Cerave, and contributes to Women’s Health Magazine.Learn more about Dr. Zirwas.
More resources about spontaneous hives:
Chronic Urticaria Management, Resources & Glossary of Terms: https://allergyasthmanetwork.org/health-a-z/chronic-urticaria/management-and-resources/
What is Chronic Urticaria: https://allergyasthmanetwork.org/health-a-z/chronic-urticaria/
More information about Omalizumab (Xolair): https://www.xolair.com/chronic-spontaneous-urticaria.html
Other episodes about urticaria:
We thank Novartis for sponsoring this podcast.
Urticaria Treatments and Causes in a Nutshell
How These Drugs Work: Impact on Mast Cells
Dr. Zirwas uses a water balloon analogy to explain CSU and help explain the mechanisms of action in these treatments, making it easier to understand how they work:
Xolair (omalizumab): A monoclonal antibody that targets IgE, a key player in allergic reactions. By binding to IgE, Xolair prevents it from attaching to mast cells, reducing the likelihood of these cells releasing histamine and other inflammatory substances that cause hives. In Dr. Zirwas's analogy, Xolair sticks to the needles so they cannot pop the water balloon.
Dupixent (dupilumab): This biologic targets the IL-4 and IL-13 pathways involved in the type 2 inflammatory response. By inhibiting these pathways, dupilumab reduces mast cell activity, helping control CSU symptoms.
Remibrutinib: A BTK (Bruton tyrosine kinase) inhibitor, Remibrutinib works by blocking a key enzyme involved in mast cell activation. This inhibition prevents the release of histamine and other mediators that contribute to CSU. According to Dr. Zirwas, Remibrutinib takes out one of the links in the chain of events inside the water balloon that would otherwise cause it to pop.
Barzolvolimab: This is still in trials and is predicted to be available in 5 years. Barzolvolimab targets the C KIT receptor on mast cells, which is critical for their survival and function. By blocking this receptor, Barzolvolimab reduces the number of mast cells, offering a novel approach to managing CSU.
The Underlying Causes of Chronic Spontaneous Urticaria: Autoimmune vs. Autoallergic
Autoimmune CSU: In autoimmune CSU, the body's immune system mistakenly targets its own tissues, leading to chronic hives. This form of CSU is often associated with other autoimmune diseases.
Autoallergic CSU: In autoallergic CSU, the immune system produces IgE antibodies against the body’s own proteins, leading to an allergic reaction. This type of CSU behaves more like a typical allergy, but against the body’s own tissues.
Timestamps
The Future of Urticaria Research
00:57 Dr. Zirwas's Bio
01:34 How Dr. Zirwas Explains CSU to Patients
05:40 Using Antihistamines to Treat CSU
06:59 When to Start with a Biologic: Omalizumab
09:41 Using Dupilumab to Treat Chronic Hives
12:24 Using Remibrutinib to Treat CSU
16:00 Understanding BTK Inhibitors and Doctor Concerns
18:06 How Remibrutinib Works
21:45 Using Barzolvolimab to Treat CSU
23:44 Shared Decision-Making with Medications
24:52 Recap of Barzolvolimab
25:46 Research into the Underlying Causes of CSU
