Meta-analysis: Omalizumab Alleviates Psychiatric Comorbidities of Chronic Spontaneous Urticaria

The analysis included more than 1,300 patients across seven studies. 

A new review suggests that omalizumab was associated with a reduction in psychiatric cormidities in a number of different studies and settings. 

The systematic review and meta-analysis sourght to assess the clinical impacts of omalizumab on depression, anxiety, and sleep disturbances in patients with chronic spontaneous urticaria (CSU). The review encompassed seven studies with a total of 1,398 patients, predominantly female with mean ages ranging from 44.6 to 46.4 years. The studies included in the analysis were classified as fair to good quality and had a low risk of bias; the research was selected from databases including Medline, Embase, and CENTRAL.

Results of the analysis indicated significant reductions in depressive symptoms among CSU patients treated with omalizumab, with a standardized mean difference (SMD) of 1.07 (95%CI 0.68-1.46, P<0.001) observed across three studies involving 124 patients. Notably, a randomized controlled trial (RCT) demonstrated that patients on omalizumab were more likely to no longer meet clinical criteria for depression compared to those on placebo (OR 5.55, 95%CI 1.7-18.2, P=0.005). Treatment with omalizumab led to significant reductions in anxiety scores (SMD=1.00, 95% CI 0.72-1.27, P<0.001) across two studies that included 257 patients.

A moderate improvement in sleep quality was observed with omalizumab treatment (SMD=0.43, 95% CI 0.34-0.53, P=0.001) versus placebo in three randomized controlled trials of over 900 patients, with the most notable response observed in patients receiving 300 mg of omalizumab every 4 weeks.

The authors suggested that the mechanism underlying these improvements is likely linked to omalizumab's inhibition of mast cell degranulation and subsequent reduction in pro-inflammatory cytokines such as TNF-alpha and interleukin-6. 

"This review lends further support to the use of omalizumab in the management of moderate-to-severe CSU," the authors wrote in the paper. "Patients with CSU receiving omalizumab reported markedly improved symptoms of depression, anxiety, and sleep disturbances, and were more likely to have resolution of CSU-associated depression. Furthermore, omalizumab was found to be effective in reducing the psychiatric impacts of CSU on patients, independent of their cutaneous response. Thus, clinicians may wish to consider the use of omalizumab as an effective treatment not only for the cutaneous symptoms of CSU, but also for the psychiatric comorbidities resulting from this disease."