TOPLINE:

Among patients with chronic spontaneous urticaria (CSU), omalizumab yielded greater reductions in disease activity and itch severity scores (ISS) than dupilumab at 12 weeks.

METHODOLOGY:

• Researchers conducted a matching-adjusted indirect comparison of phase 3 trials, using placebo as a common comparator, to evaluate the efficacy of omalizumab vs dupilumab in patients with CSU.
• They matched the baseline weekly urticaria activity score (UAS7) distribution of 1000 randomly selected ASTERIA I/II (omalizumab) patients to that of LIBERTY‑CSU CUPID Study A (dupilumab) patients and then compared their outcomes.
• Changes in urticaria activity and itch severity from baseline to 12 weeks were measured using UAS7 and ISS7, respectively (higher scores indicated worse outcomes).

TAKEAWAY:

• At 12 weeks, omalizumab reduced UAS7 by a mean of 12.6 points compared with placebo, whereas dupilumab reduced UAS7 by a mean of 5.0 points compared with placebo; the 7.6-point difference was significant (P = .006).
• Similarly, at 12 weeks, omalizumab reduced ISS7 by a mean of 5.4 points compared with placebo, whereas dupilumab reduced ISS7 by a mean of 2.4 points compared with placebo; the 3-point difference was significant and favored omalizumab (P = .031).

IN PRACTICE:

“Although a direct head-to-head trial is needed for confirmation, our findings may help physicians and patients make informed treatment decisions for this debilitating chronic disease,” the authors wrote.

SOURCE:

Michael Holden, MD, Genentech, Inc., South San Francisco, California, was the corresponding author of the study, which was published online on February 14, 2026, in the Journal of Allergy and Clinical Immunology: Global.

LIMITATIONS:

Cross‑trial heterogeneity — including differences in demographics, clinical features, background antihistamine therapy, study period, and primary endpoint timing (week 12 vs week 24) — may have altered baseline severity and outcomes.

DISCLOSURES:

The ASTERIA I/II trials were funded by Genentech, Inc., a member of the Roche Group, and Novartis Pharma AG. The LIBERTY-CSU CUPID Study A trial was funded by Sanofi and Regeneron. Three authors reported being employees of Genentech, Inc., and stockholders in Roche. Some authors reported receiving consulting, advisory board, and/or speaking fees or research, grant, or clinical trial support from various pharmaceutical companies, including the trial funders.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.