When managing chronic spontaneous urticaria (CSU), therapeutic response can vary widely between patients - particularly based on factors like body mass index (BMI), sex, or a history of angioedema. But a new analysis from the LIBERTY-CSU CUPID studies (A and C) suggests that dupilumab, the IL‑4 and IL‑13 pathway–targeting biologic already approved for several atopic conditions, offers consistent benefits across these diverse patient groups.
The pooled study, recently published in the Journal of Allergy and Clinical Immunology (February 2026), evaluated 289 omalizumab-naïve CSU patients who received either dupilumab or placebo for 24 weeks. Researchers assessed change from baseline in the 7‑day Itch Severity Score (ISS7) and 7‑day Urticaria Activity Score (UAS7), stratified by BMI category, angioedema status, and gender.
Across the board, dupilumab outperformed placebo by clinically meaningful margins. By week 24, patients on dupilumab achieved:
Greater itch reduction (ISS7 improvements of roughly –9 to –11 vs –6 with placebo)
Stronger control of hives (UAS7 reductions of about –18 to –21 vs –12 to –14 with placebo)
Broader consistency, regardless of baseline characteristics - including those with or without angioedema, men and women, and normal to obese BMI strata
Perhaps most reassuringly, the safety profile aligned with known dupilumab experience across other allergic diseases, showing no new safety signals.
Clinical takeaway: Dupilumab’s efficacy in CSU appears robust and uniform across key demographic and disease subgroups. For clinicians treating refractory itch and hives, this reinforces dupilumab as a promising therapeutic option even before omalizumab or in biologic-naïve patients.
References:
https://www.sciencedirect.com/science/article/pii/S009167492501190X