Table 1.

Clinical outcomes and tolerability with cyclosporine for cohort of patients with omalizumab-refractory chronic urticaria

	Patient #1	Patient #2	Patient #3	Patient #4	Patient #5
Age	24	35	41	39	58
Gender	Female	Male	Female	Male	Female
Comorbidities	None	Vitiligo, chronic rhinitis	Hypertension, headaches, chronic rhinitis	Asthma, chronic rhinitis, hyperthyroidism	Asthma, chronic rhinitis, thyroid cancer (s/p thyroidectomy), hypertension
BMI	26 kg/m2	36 kg/m2	35 kg/m2	33 kg/m2	34 kg/m2
Urticaria type	Chronic spontaneous urticaria	Chronic spontaneous urticaria	Chronic spontaneous urticaria	Chronic inducible urticaria	Chronic spontaneous urticaria
Urticaria Duration	7 months	12 months	9 months	18 months	12 months
Pertinent laboratory studies	ANA, RF, and cryoglobulin negative. Normal TSH. Anti-TPO and Anti-thyroglobulin antibodies negative	ANA negative. Normal TSH	Normal TSH	ANA negative. Anti-TPO and Anti-thyroglobulin antibodies negative	ANA negative. Anti-thyroglobulin antibodies negative
Prior use of corticosteroids	Yes	No	Yes	No	Yes
Omalizumab Dose	300 mg every 4 weeks	300 mg every 4 weeks	300 mg every 4 weeks	300 mg every 4 weeks	300 mg every 4 weeks
Omalizumab treatment duration	20 weeks	48 weeks	12 weeks	52 weeks	12 weeks
Cyclosporine Dose (milligram per kilogram per day)	3	1	1	1; dose later increased to 3	1.25; dose later increased to 3
Cyclosporine dosage categorya	Low-Dose	Very Low-Dose	Very Low-Dose	Very Low-Dose (initially) low-dose was later used due to lack of clinical improvement	Very low-dose (initially) low-dose was later used during a recurrence when symptoms failed to respond to very low doses
Cyclosporine treatment duration	16 weeks	16 weeks	30 weeks	44 weeks	24 weeks
Concomitant medicationsb	Cetirizine 20 mg twice daily, Ranitidine 150 mg twice daily	Fexofenadine 360 mg twice daily, Ranitidine 150 mg twice daily	Cetirizine 20 mg twice daily, Ranitidine 150 mg twice daily, Hydroxyzine 25 mg daily every evening, Montelukast 10 mg daily	Cetirizine 10 mg twice daily, Fexofenadine 180 mg daily, Hydroxyzine 25 mg daily every evening, Ranitidine 150 mg twice daily, Montelukast 10 mg daily	Cetirizine 20 mg twice daily, Ranitidine 150 mg twice daily, Montelukast 10 mg daily
Clinical Response to cyclosporinec	Complete response	Complete response	Complete response	Near-complete improvement of cholinergic urticaria, moderate improvement of pressure-induced urticaria	Complete response
Time to clinical improvement on cyclosporine therapy	2 weeks	1 week	2 weeks	24 weeks	1 week
Relapse (if remission had occurred)	No	No	Yes	N/A	Yes
Adverse effects of cyclosporine	None	None	During second course of cyclosporine developed hypertension (did not prompt drug discontinuation)	Hypertension, hyperglycemia, hematuria, elevated uric acid (prompting cessation)d	During second course of cyclosporine developed elevated creatinine (peak 1.24 from baseline 1.00), prompting cessatione

^aCyclosporine dosage is categorized into 2 groups: (1) very low (< 2 mg/kg/d) and (2) low (2–3.99 mg/kg/d) dose

^bSame doses were used during omalizumab and cyclosporine treatment

^cPatient observation, which informed provider documentation, was used to characterize clinical response rates

^dBlood pressure, blood glucose, serum uric acid, and hematuria normalized after cessation of cyclosporine

^eSerum creatinine returned to baseline after cessation of cyclosporine