Immune thrombocytopenic purpura (ITP) is an immune-mediated disorder in which there is less number of platelets in the blood. A decrease in blood platelets can lead to easy bruising, bleeding gums, internal bleeding, and reddish-purple spots on the lower leg. Rituximab has become a widely used treatment option for chronic ITP. 40 to 60% of chronic ITP patients achieve a partial or complete platelet response following their initial 4 infusions with standard-dose rituximab. Despite this good response rate, only 15–20% of patients sustain responses lasting at least 3 years. Therefore, more than 70 to 80% of the treated patients will not achieve a response or will respond but the disorder will…

Bullous pemphigoid is a rare skin condition and is mainly seen in older people. It starts with an itchy, raised rash and as the condition develops, large blisters are formed on the skin. The current treatment for bullous pemphigoid is not effective for many patients and this is where biologic drugs like dupilumab, ligelizumab, rituximab, and omalizumab, etc come in. For now, let’s look at some case studies on how omalizumab can be effective for bullous pemphigoid. 1. The first case study shows that 6 patients with BP used omalizumab and the doctor checked in on them for up to 42 months. 5 of the 6 patients with BP received therapeutic…

Immunoglobulin E (IgE) is a key factor of allergic rhinitis (It is an inflammation inside the nose caused by allergens, such as pollen, dust, mold, and also the flakes of skin from certain animals) and omalizumab (Xolair), a biologic drug helps in the removal of this circulating free IgE. Omalizumab seems to be an effective treatment strategy for allergic rhinitis but, the high cost of omalizumab is one reason why it cannot be used to treat allergic rhinitis and it is not FDA approved for this reason. The current treatments for allergic rhinitis include corticosteroids, mast cell stabilizers, leukotriene receptor antagonists, anticholinergics, antihistamines, and allergen immunotherapy which can have long-term…

Many studies show that omalizumab is effective for Allergic bronchopulmonary aspergillosis (ABPA) and that it can help many patients, but no regulatory authority has not approved it. Let’s take a look at some of these studies. 1. 102 cases from 30 published literature were analyzed and it said that omalizumab therapy in ABPA not only provided a reduction in serum IgE, exacerbation rates, and steroid requirement but also showed reduced asthma symptoms and improved pulmonary functions in patients with ABPA. 2. Another study included 18 patients who had ABPA along with cystic fibrosis and omalizumab was able to treat it with less side effects compared to long-term corticosteroids. 3. This…

Chronic inflammatory Demyelinating Polyradiculoneuropathy (CIPD) is a rare autoimmune disease in which the body attacks its own tissues. Rituximab is a biologic drug that is known to treat diseases like non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA), and pemphigus Vulgaris. It seems to be effective for the treatment of CIDP, but it is not approved by any regulatory authority. Let’s look at one case study and see how it can help CIPD: 1. A total of 5 patients were identified who had received rituximab for the treatment of CIDP. These have been previously treated with multiple therapies and there was no response. The normal treatments…

What is XOLAIR and what is it used for? XOLAIR is an anti-IgE antibody. It is an injectable prescription medicine used to treat: Moderate to severe asthma in people (6 years and older) whose asthma symptoms are not well controlled with the normal asthma medicines called inhaled corticosteroids. A skin or blood test will be performed to see if you have allergies to year-round allergens. It is unknown if XOLAIR is safe and effective in people with asthma under 6 years of age. Nasal polyps (Add-on maintenance treatment) in people 18 years of age and older when the normal medicines to treat nasal polyps called nasal corticosteroids have not worked…

ABPA is treated with a combination of oral corticosteroids and anti-fungal medications. Inhaled corticosteroids are not effective in treating ABPA and treatments with oral corticosteroids are needed for months. The second type of treatment used is an anti-fungal medication, like itraconazole and voriconazole. These medicines help kill Aspergillus (a fungus) so that it no longer colonizes the airway. Usually, one of these drugs is given for at least 3 to 6 months. However, even this treatment does not cure you of ABPA and can have side effects. There are some studies showing that dupilumab can be used in the treatment of ABPA, but it has not been approved by any…

Allergic fungal rhinosinusitis (AFRS) is a distinct subtype of chronic rhinosinusitis with nasal polyps (CRSwNP). It is characterized by a disease with non-invasive fungal hyphae, which causes immunoglobulin E (IgE)-mediated mucosal hypersensitivity resulting in the formation of eosinophilic mucin. Unlike other subtypes of CRSwNP, studies showed that the IgE level is very high in AFRS. Allergic fungal rhinosinusitis requires surgical debridement (removing damaged tissue) along with medical therapy. Many patients can have AFRS recurrence post-surgery, so the patients should use topical steroids. Dupilumab has been able to treat chronic rhinosinusitis with nasal polyps (CRSwNP) and should be able to treat AFRS, but it is under the Dupilumab Development Program (a program where two companies…

People with prurigo nodularis experience persistent itch, with thick skin lesions (called nodules) that can cover most of the body. It is described as painful with burning, stinging, and tingling of the skin. The signs and symptoms of prurigo nodularis can negatively impact health-related quality of life, including mental health, activities of daily living, and social interactions. High-potency topical steroids are commonly used to treat prurigo nodularis, which can cause risks to the body if used long-term. Dupilumab is a biologic drug that works very differently from other drugs and has significantly reduced itch and skin lesions and improved quality of life. In the phase 3 trial, dupilumab compared with…

Chronic spontaneous urticaria (CSU) is a chronic inflammatory skin disease that results in the sudden onset of hives on the skin and swelling deep under the skin. People with CSU often experience symptoms including a persistent itch or burning sensation, which can significantly impact their quality of life. Swelling usually occurs on the face, hands, and feet, affecting the throat and upper airways. CSU is typically treated with antihistamines but, in 50% of people living with CSU their disease remains uncontrolled and only a few treatment options are available. CSU is the fifth inflammatory disease for which Dupilumab has achieved positive Phase 3 data, including atopic dermatitis (eczema), asthma, chronic…