High dose Xolair may be a treatment option for patients with chronic hives who fail the standard treatment dose of 300mg monthly. Xolair (omalizumab) is a monoclonal anti-IgE antibody for patients who have chronic spontaneous urticaria who fail the 4 fold standard dosing of antihistamines.
A recent study published in the Journal of Allergy and Clinical Immunology: In Practice, increased the dose of Xolair in patients who failed to respond to the standard Xolair 300mg dosage.
All patients were initially treated with Xolair 300mg for 4 weeks. Patients who failed to respond after 5 injections, updosing was offered.
The high dose Xolair offered was 450 mg or 600 mg every 4 weeks. If treatment response was still insufficient after 3 doses of 600mg of Xolair, treatment interval could be shortened to 2 weeks. Xolair was discontinued in cases in which 2 consecutive doses of 600 mg at 2-week interval yielded insufficient response.
A total of 166 patients were treated with Xolair. Higher doses of Xolair were introduced after an average of 8 administrations of a standard dose of 300mg every 4 weeks. 61% of the patients who received the higher dose of Xolair showed an improved treatment response, about half of them showed a complete response and the other half of them showed a partial response. Approximately 40% of them did not improve from updosing.
We discussed in another blog post, other alternatives to treatment failures in chronic urticaria with Xolair.
Although high dose Xolair is generally used in patients with asthma based on their weight and IgE level, it is rarely used in chronic idiopathic urticaria. Other smaller studies have showed comparable results, anywhere from 45%-83% of partial or complete response.
The most frequent side effects during high dose Xolair treatment were headache, fever like sensations and tiredness, which were not increased compared to standard treatment. Likewise, higher doses of Xolair are well tolerated in patients with asthma.