Q&A: Dupilumab Improves Quality of Life in Omalizumab-Naive CSU

Dupilumab (Dupixent) improved disease-specific quality of life versus placebo in omalizumab-naive adults and adolescents with chronic spontaneous urticaria (CSU), per a post hoc pooled analysis of the phase 3 LIBERTY-CSU CUPID A and C trials.¹

Among 289 patients, dupilumab diminished overall Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) scores by the 24-week mark (least squares mean difference, −5.27; 95% CI, −9.33 to −1.20; P = .0111), with nominal gains observed in the pruritus, limits, and looks domains.¹˒² The study’s investigators also reported improvements on 22 of the questionnaire's 23 individual items, with work as the only exception.²

Presented at the 2026 European Academy of Dermatology and Venereology (EADV) Congress in Vienna, Austria, the findings extend earlier CUPID data on itch and hive reduction into patient-reported outcomes tied to daily functioning and self-image.¹˒² Thomas B. Casale, MD, professor of medicine and pediatrics at the University of South Florida Morsani College of Medicine, served as first author on the analysis. Below, Casale shares his perspective on what these quality of life gains mean for clinicians managing CSU:

HCPLive: What was this analysis designed to look at, and why focus on quality of life after the CUPID trials had already shown improvements in itch and hives?

Thomas B. Casale, MD: CSU is a disease that can greatly impact a person’s quality of life because of things like feelings of embarrassment due to visible hives or not being able to sleep because of persistent itch. This analysis was designed to evaluate the impact of dupilumab on the multidimensional burden of CSU across six distinct domains that comprehensively reflect patients’ lived experience. We measured this using The Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), the only validated urticaria-specific health-related quality of life instrument for CSU.

HCPLive: The biggest gains were in the pruritus, limits, and looks domains. What do those results tell us about how dupilumab affects patients' daily lives?

Thomas B. Casale, MD: These results show that dupilumab improved multiple aspects of patients’ health-related quality of life, including physical symptoms and psychosocial wellbeing. The Pruritus domain measured how bothered patients were by hives and itch. The Limits domain measured how much patients were feeling down, and how limited they were in their choice of food and their participation in sports. The Looks domain measured how embarrassed patients were by marks on their body and to go out in public, any difficulty in using cosmetics, how much CSU affected their choice in clothing, and if they were bothered by medication side effects.

HCPLive: More patients on dupilumab reported no swelling burden at all. What does this suggest about dupilumab's effect on angioedema?

Thomas B. Casale, MD: With 74.3% of patients treated with dupilumab reporting no swelling burden at 24 weeks, significantly higher than the 60% of patients treated with placebo, dupilumab may also improve angioedema related to CSU in some patients. However, in the pre-specified endpoint of Angioedema Activity Score over 7 days in Study A and Study C, there was not a significant difference between dupilumab and placebo.

HCPLive: What did you see for adverse events in the CUPID program, and how would you describe the tolerability of dupilumab in patients with CSU?

Thomas B. Casale, MD: The most common adverse event in CSU is injection site reaction. Other adverse events fell below the 2% threshold across Study A and Study C in patients 12 years and older. There is also no initial or ongoing lab monitoring required for patients treated with dupilumab. This means that dupilumab is well tolerated in a majority of patients with CSU.

HCPLive: What questions remain, and where does this research go next, whether longer-term follow-up, omalizumab-experienced patients, or real-world use?

Thomas B. Casale, MD: Study A and Study C have completed, but we continue to do additional analyses on collected data and plan to share results at future congresses.

Editor’s note: This summary has been edited for grammar and clarity using artificial intelligence tools. Casale's university employer has reported receiving grants and consulting fees from Genentech, Inc, and Novartis.

References

1. Casale TB, Bernstein JA, Metz M, et al. Dupilumab improves disease-specific quality of life in omalizumab-naïve patients with chronic spontaneous urticaria: a post-hoc pooled analysis from the LIBERTY-CSU CUPID A and C phase 3 trials. E-poster P2716. Presented at: 2026 European Academy of Dermatology and Venereology Congress; September 30, 2026; Vienna, Austria.

2. Smith T. CUPID A and C: dupilumab improves quality of life in omalizumab-naive CSU. HCPLive. Published September 30, 2026. Accessed October 5, 2026. https://www.hcplive.com/view/cupid-a-c-dupilumab-improves-quality-life-omalizumab-naive-csu.