Chronic Urticaria Treatment with Omalizumab—Verification of NLR, PLR, SIRI and SII as Biomarkers and Predictors of Treatment Efficacy

Abstract

Biomarkers that are able to predict the response to omalizumab (OMA) in chronic spontaneous urticaria (CSU) are highly valued. The aim of our study was to evaluate the UAS7 (urticaria activity score assessed for 7 days), DLQI (dermatology life quality index), SII (systemic immune-inflammation index), SIRI (systemic inflammation response index), PLR (platelet/lymphocyte ratio) and NLR (neutrophil/lymphocyte ratio) in a group of 46 CSU a patients treated for 24 weeks with OMA (300 mg every 4 weeks). There were no statistically significant differences observed at the start nor at the end of the treatment between the two groups (responders vs. non-responders) and SII, SIRI, PLR and NLR. However, a statistically significant correlation was observed between severity of urticaria expressed in UAS7 scores and the quality of life (evaluated by DLQI). Furthermore, at week 24, both groups demonstrated significant improvement in quality of life. Our single center study did not confirm the usefulness of SII, SIRI, NLR or PLR as predictors of the response to OMA in CSU. However, it is of importance that even patients who did not respond to the treatment presented a significant improvement in quality of life. Additionally, we also observed that the efficacy of treatment was unchanged amongst patients who underwent a second series of treatment in cases of relapse.

The effectiveness of omalizumab therapy in patients with chronic spontaneous urticaria: the experience of a single-centre study in Poland

“…The mean DLQI at the beginning of treatment was slightly higher than in pivotal studies that might relate to high initial severity scores [ 1 , 10 , 11 ]. Yet, in each cycle we observed a significant improvement in DLQI scores, which is in line with other research [ 1 , 10 , 11 , 14 , 15 ]. Furthermore, some patients experienced an improvement in the quality of life despite not responding fully to treatment.…”

Predicting responses to omalizumab in antihistamine-refractory chronic urticaria: A real-world longitudinal study

“… 28 Recent studies have explored the impact of omalizumab on platelet and inflammatory markers in patients with CU, but these have yielded inconsistent and inconclusive results. 17 , 29 , 30 In our study, we observed a notable trend of higher PLRs being associated with a higher likelihood of being a late responder to omalizumab treatment. However, PLR was not found to predict nonresponse to omalizumab.…”

Biomarkers for Monitoring Treatment Response of Omalizumab in Patients with Chronic Urticaria

“…The study found that responders exhibited significantly higher SII and SIRI levels compared to non-responders at three and six months after initiating omalizumab treatment [29]. However, a recent study failed to verify the utility of these biomarkers [31].…”

“…One study [27] 1613 SIRI/SII/PLR/NLR Increase Predictive of response to omalizumab Contradictory [28] 252 (106 completed) [29] 124 [30] 143 [31] 56 [34] Review…”

“…The two studies on basophils both showed an increase in basophils after omalizumab treatment, and one was a placebo-controlled trial [23,26]. All in all, the studies on SIRI, SII, PLR, and NLR are conflicting [28][29][30][31].…”