FDA to Review Dupilumab for Treating Chronic Spontaneous Urticaria

Heidi Splete

March 08, 2023

The Food and Drug Administration has accepted a supplemental Biologics License Application (sBLA) for dupilumab for a new indication: The treatment of chronic spontaneous urticaria (CSU) in adolescents and adults aged 12 years and older that is inadequately controlled by current standard of care.

CSU is an inflammatory skin condition that causes sudden hives and angioedema, most often on the face, hands, and feet. However, the throat and upper airways also can be affected. CSU is generally treated with H1 antihistamines, but this strategy is insufficient for approximately 50% of patients, according to a press release from the manufacturer, Regeneron, announcing the FDA acceptance of the application on March 7.

Dupilumab (Dupixent), first approved in 2017 for treating atopic dermatitis in adults, is a fully human monoclonal antibody that inhibits the signaling of the interleukin (IL)-4 and IL-13 pathways.

The application for FDA approval for CSU is based on data from a pair of phase 3 trials in two different populations, LIBERTY-CUPID A and B.

The first study (LIBERTY-CUPID A) randomized 138 CSU patients aged 6 years and older who were uncontrolled on antihistamines to additional treatment with dupilumab or placebo over 24 weeks. The dupilumab-treated patients showed a 63% reduction in itch severity compared with a 35% reduction in patients who received the placebo, measured by changes in a 0-21 itch severity scale, according to data presented at the 2022 American Academy of Allergy, Asthma and Immunology (AAAAI) meeting.

Patients in the dupilumab group also showed a 65% reduction in the severity of urticaria activity (itch and hives) compared with 37% of those on placebo. Overall rates of adverse events were similar between groups; the most common were injection site reactions, according to the company.

The second study (LIBERTY-CUPID B) assessed efficacy and safety of dupilumab in 108 patients with CSU aged 12-80 years who were symptomatic despite standard-of-care treatment and were intolerant or incomplete responders to the anti-IgE antibody omalizumab (Xolair), approved for CSU. Last year, the company announced that this study had been halted after an interim analysis found that while there were positive numerical trends in reducing itch and hives, they "did not meet statistical significance." In the March 7 press release, the company said that results from this study provide "additional supporting data" for the approval application.

The target date for the FDA's decision is Oct. 22, 2023, according to Regeneron. Regeneron and Sanofi also are investigating dupilumab for treating chronic inducible urticaria triggered by cold in a phase 3 study.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.