Dermatological Diseases, Immunology CE/CME ACCREDITED Watch Time: 37 mins

touchPANEL DISCUSSION Unlocking the pathogenesis of chronic spontaneous urticaria to inform the future treatment landscape

Leading experts explain how recent advances in our understanding of the pathogenesis of chronic spontaneous urticaria is guiding emerging targeted therapies, and consider how they may refine future management to reduce its impact on patient quality of life.

Prof. Dr med. Marcus Maurer

Charité University Medicine, Berlin, Germany

CHAIR

Panelists:
Dr Melinda Gooderham, Prof. David Khan
 
Video Chapters
Introduction

Prof. Dr med. Marcus Maurer introduces the faculty and topics for discussion on the diagnosis and management of CSU.

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1/4 Next Chapter
 
Diagnosing CSU: Reducing the impact on patients

The panel considers the burden of CSU and the importance of making a differential diagnosis, and reflects on how best to measure disease severity and impact on the patient’s quality of life and function.

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2/4 Next Chapter
 
What lies beneath: The pathogenesis of CSU

The panel explores recent scientific advances in our understanding of CSU pathogenesis, and discusses the potential implications of emerging endotypes for the development of novel treatments that target underlying disease mechanisms.

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3/4 Next Chapter
 
CSU treatment landscape: Current recommendations and future therapies

After appraising the latest guidelines and available treatments, the panel considers how emerging agents currently in clinical development may inform future patient management approaches.

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Overview & Learning Objectives
Overview

In this activity, the expert panel discusses the burden of disease and how recent advances in our understanding of the pathogenesis of chronic spontaneous urticaria may help to inform future treatment approaches for improved control of symptoms.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of immunologists, allergists and dermatologists involved in the management of chronic spontaneous urticaria.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Dr med. Marcus Maurer discloses: Speaker/advisor for and/or has received research funding from Allakos, Allerdia, Amgen, Aralez Bio, Argenx, AstraZeneca, Celldex Therapeutics, Centogene, CSL Behring, FAES Farma, Genentech, GI Innovation, Innate Pharma, Kyowa Kirin, Leo Pharma, Lilly, Menarini, Moxie Pharmaceutical, Novartis, Pfizer, Roche, Sanofi/Regeneron, Third Harmonic Bio, UCB and Uriach.

Dr Melinda Gooderham discloses:  Advisory board/panel fees from AbbVie Inc., Amgen, AnaptysBio, Arcutis Pharmaceuticals Inc., Asana BioSciences, Aslan Pharmaceuticals, Bausch Health, Boehringer Ingelheim International GmbH, Celgene Corporation, Eli Lilly and Company, Galderma SA., Janssen Inc., Leo Pharma, Novartis Pharmaceuticals, Pfizer Inc., Regeneron Pharmaceuticals Inc., Sanofi Genzyme, Sun Pharmaceuticals and UCB. Consultant fees from AbbVie Inc., Akros Pharma Inc., Amgen, AnaptysBio, Aslan Pharmaceuticals, Bausch Health, Boehringer Ingelheim International GmbH, Celgene Corporation, Eli Lilly and Company, Incyte, Janssen Inc., Kyowa Kirin, Novartis Pharmaceuticals, Sanofi Genzyme, Sun Pharmaceuticals and UCB. Grants/research support from AbbVie Inc., Akros Pharma Inc., Amgen, AnaptysBio, Arcutis Pharmaceuticals Inc., Asana BioSciences, Bausch Health, Boehringer Ingelheim International GmbH, Bristol Myers Squibb Company, Celgene Corporation, Coherus Biosciences, DermiraInc., Eli Lilly and Company, Galderma SA., GlaxoSmithKline, Incyte, Janssen Inc., Kyowa Kirin, Leo Pharma, MedImmune, Merck and Co., Novartis Pharmaceuticals, Pfizer Inc., Regeneron Pharmaceuticals Inc., Roche Laboratories, Sanofi Genzyme, Sun Pharmaceuticals, Takeda Pharmaceuticals and UCB.

Prof. David Khan has no interests/relationships or affiliations to disclose in relation to this activity.

Content reviewer

Ann Lin, DO has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 11 April 2022. Date credits expire: 11 April 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Recognize the burden of disease of chronic spontaneous urticaria (CSU) and the importance of a differential diagnosis
  • Describe the underlying pathogenesis of CSU and how it can inform the development of future treatments
  • Recall the current treatment recommendations for CSU and evaluate potential new treatments in development
Faculty & Disclosures
Prof. Dr med. Marcus Maurer

Charité University Medicine, Berlin, Germany

Marcus Maurer, MD, is Professor of Dermatology and Allergy at the Charité University Medicine in Berlin, Germany. read more

Prof. Maurer is also Co-Director of the Fraunhofer Site for Allergology and Immunology at the Fraunhofer Translational Medicine and Pharmacology ITMP, and Executive Director for the Institute of Allergology at Charité University Medicine. 

A leading expert in the fields of allergy and dermatology, Prof. Maurer is a coordinator of the Global Allergy and Asthma European Networks (GA²LEN) and Centres of Reference and Excellence for urticaria (UCARE) and angioedema (ACARE).

His areas of clinical interest include urticaria, angioedema, mastocytosis, pruritus, skin infections and allergic diseases. Active in research, Prof. Maurer’s work focuses on mast cell biology, neuroimmunology, inflammation, innate immunity and tolerance. He has supervised more than 60 clinical trials (phases I through IV), contributed to over 650 publications in peer-reviewed journals, alongside 45 books and book chapters.

Prof. Dr med. Marcus Maurer discloses: Speaker/advisor for and/or has received research funding from Allakos, Allerdia, Amgen, Aralez Bio, Argenx, AstraZeneca, Celldex Therapeutics, Centogene, CSL Behring, FAES Farma, Genentech, GI Innovation, Innate Pharma, Kyowa Kirin, Leo Pharma, Lilly, Menarini, Moxie Pharmaceutical, Novartis, Pfizer, Roche, Sanofi/Regeneron, Third Harmonic Bio, UCB and Uriach.

Dr Melinda Gooderham

SKiN Centre for Dermatology, Ontario, Canada

Melinda Gooderham, MSc, MD, FRCPC, is Consultant Dermatologist and Medical Director at the SKiN Centre for Dermatology in Ontario, Canada. read more

Dr Gooderham is also an Assistant Professor at Queen’s University, a Consultant Physician at the Peterborough Regional Health Centre, and an Investigator with Probity Medical Research, Canada. She is a fellow of the Royal College of Physicians and Surgeons of Canada.

Dr Gooderham is actively involved in teaching medical students, residents, nurse practitioners and physicians, with both didactic and clinical hands-on teaching. Her clinical practice focuses on psoriasis, atopic dermatitis, skin cancer and clinical research. As an author and reviewer, Dr Gooderham contributes to peer-reviewed publications in the field of dermatology.

Dr Melinda Gooderham discloses: Advisory board/panel fees from AbbVie Inc., Amgen, AnaptysBio, Arcutis Pharmaceuticals Inc., Asana BioSciences, Aslan Pharmaceuticals, Bausch Health, Boehringer Ingelheim International GmbH, Celgene Corporation, Eli Lilly and Company, Galderma SA., Janssen Inc., Leo Pharma, Novartis Pharmaceuticals, Pfizer Inc., Regeneron Pharmaceuticals Inc., Sanofi Genzyme, Sun Pharmaceuticals and UCB. Consultant fees from AbbVie Inc., Akros Pharma Inc., Amgen, AnaptysBio, Aslan Pharmaceuticals, Bausch Health, Boehringer Ingelheim International GmbH, Celgene Corporation, Eli Lilly and Company, Incyte, Janssen Inc., Kyowa Kirin, Novartis Pharmaceuticals, Sanofi Genzyme, Sun Pharmaceuticals and UCB. Grants/research support from AbbVie Inc., Akros Pharma Inc., Amgen, AnaptysBio, Arcutis Pharmaceuticals Inc., Asana BioSciences, Bausch Health, Boehringer Ingelheim International GmbH, Bristol Myers Squibb Company, Celgene Corporation, Coherus Biosciences, DermiraInc., Eli Lilly and Company, Galderma SA., GlaxoSmithKline, Incyte, Janssen Inc., Kyowa Kirin, Leo Pharma, MedImmune, Merck and Co., Novartis Pharmaceuticals, Pfizer Inc., Regeneron Pharmaceuticals Inc., Roche Laboratories, Sanofi Genzyme, Sun Pharmaceuticals, Takeda Pharmaceuticals and UCB.

Prof. David Khan

Southwestern Medical Center, University of Texas, USA

David Khan, MD, is Professor of Internal Medicine and Pediatrics at the University of Texas Southwestern Medical Center in Dallas, Texas, USA, where he has been Program Director for the Allergy & Immunology fellowship programme since 1998. read more

Prof. Khan is the current president of the American Academy of Allergy, Asthma, and Immunology (AAAAI); is a past president of the Texas Allergy, Asthma and Immunology Society; and was formerly a member of the Joint Task Force on Practice Parameters for Allergy & Immunology.

His research interests include refractory chronic urticaria, drug allergy and mood disorders in asthma.

Prof. David Khan has no interests/relationships or affiliations to disclose in relation to this activity.

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Question 1/5
Based on real-world data, which of the following statements best summarizes treatment and management experiences among adult patients living with CSU?

CSU, chronic spontaneous urticaria.
Correct

Data from the ASSURE-CSU study demonstrate real-world incidence of CSU-associated angioedema is higher than previously estimated, but remains under-reported and under-diagnosed despite significant impacts on patient quality of life.1,2 

Abbreviation

CSU, chronic spontaneous urticaria.

References

  1. Maurer M, et al. Allergy. 2017;72:2005–16.
  2. Sussman G, et al. Allergy. 2018;73:1724–34.
Question 2/5
Which of the following statements best describes emerging endotypic classifications based on the current understanding of autoimmunity underlying CSU pathogenesis?

CSU, chronic spontaneous urticaria.
Correct

Autoimmunity is thought to be one of the most frequent causes underlying CSU pathogenesis.1 Growing scientific and clinical evidence suggests the existence of two autoimmune CSU endotypes driven by distinct underlying type I- and type IIb-mediated autoimmunity. The type I and type IIb autoimmune pathways implicated in CSU pathogenesis are thought to drive different phenotypes and treatment responses in patients, and are associated with distinct laboratory markers.1,2

Abbreviation

CSU, chronic spontaneous urticaria.

References

  1. Kolkhir P, et al. J Allergy Clin Immunol. 2017;139:1772–81.
  2. Maurer M, et al. Int Arch Allergy Immunol. 2020;18:1321–33.
Question 3/5
Since being diagnosed with CSU 2 weeks ago, your patient has been receiving treatment with cetirizine 10 mg once a day. The patient returns to the clinic with ongoing discomfort. Based on established treatment recommendations, which of the following next steps would you consider in the management of this patient?

CSU, chronic spontaneous urticaria.
Correct

Current guidelines recommend increasing the dose of first-line second-generation H1-antihistamines up to four-fold in patients with insufficient response at the standard dose. Updosing is preferred over mixing different second-generation H1-antihistamines owing to different pharmacological properties.1 Cetirizine is listed amongst the recommended second-generation H1-antihistamines in the current CSU guidelines.1,2 

Abbreviation

CSU, chronic spontaneous urticaria.

References

  1. Zuberbier T, et al. Allergy. 2022;77:734–66.
  2. US FDA. Prescribing information: cetirizine. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2002/19835s15,%2020346s8lbl.pdf (accessed March 2022).
Question 4/5
Your patient with CSU has a history of associated angioedema that recurs with each flare-up. Which of the following would you use to assess whether recurrent angioedema is sufficiently controlled by the current treatment approach in this patient?

AAS, angioedema activity score; AECT, angioedema control test; AE-QoL, angioedema QoL questionnaire; CSU, chronic spontaneous urticaria; CU-Q2oL; chronic urticaria QoL questionnaire; QoL, quality of life.
Correct

The AECT is the first patient-reported outcome measure to assess disease control in patients affected by recurrent angioedema. Results from a recent study, which included patients with CSU and angioedema, have demonstrated that the AECT is a reliable and valid tool to determine disease control in patients with recurrent angioedema, and to screen for insufficiently controlled angioedema providing a guide for physicians to adapt therapy as needed.

Abbreviations

AECT, angioedema control test; CSU, chronic spontaneous urticaria.

Reference

Weller K, et al. J Allergy Clin Immunol Pract. 2020;8:2050–7.

Question 5/5
Which of the following accurately describes the mode of action of dupilumab and supports the concept of autoallergic mechanisms in the pathogenesis of CSU?

ɑ, alpha; CSU, chronic spontaneous urticaria; Ig, immunoglobulin; IL-interleukin; R, receptor.
Correct

Dupilumab is a monoclonal antibody that binds and blocks the ɑ-subunit of IL-4R, and inhibits IL-4R-mediated signalling induced by both IL-4 and IL-13.1,2 The IL-4/IL-13/IL-4R axis has been shown to promote TH2 cell differentiation and mediate pro-allergic adaptive immune responses implicated in allergic diseases, including the pathogenesis of CSU.1,2 Inhibition of IL-4 and IL-13-mediated signalling with dupilumab was recently shown to reduce itch and hives in patients with omalizumab-naive CSU.3

Abbreviations

ɑ, alpha; CSU, chronic spontaneous urticaria; IL, interleukin; R, receptor; TH2, T helper cell type 2.

References

  1. Harb H, Chatila T. Clin Exp Allergy. 2020;50:5–14.
  2. Maurer M, et al. Int Arch Allergy Immunol. 2020;18:1321–33.
  3. Maurer M, et al. J Allergy Clin Immunol. 2022;149(Suppl.):AB312.
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