Corticosteroid-related toxicity in patients with chronic idiopathic urticaria‐chronic spontaneous urticaria

Ledford, Dennis K.; Broder, Michael S.; Antonova, Evgeniya; Omachi, Theodore A.; Chang, Eunice; Luskin, Allan T.

doi:10.2500/aap.2016.37.3999

Cited by 19 publications

(20 citation statements)

References 19 publications

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“…In early real-world studies, patients were reported to predominantly start with CIU/CSU treated with OCS. 21 Evidence of decreased utilization of other CIU/CSU-related medications after omalizumab initiation was also reported in another real-world study.…”

Section: Discussionmentioning

confidence: 58%

Real-world use of omalizumab in patients with chronic idiopathic/spontaneous urticaria in the United States

Eghrari-Sabet¹,

Sher²,

Kavati

et al. 2018

allergy asthma proc

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Section: Discussionmentioning

confidence: 58%

Real-world use of omalizumab in patients with chronic idiopathic/spontaneous urticaria in the United States

Eghrari-Sabet¹,

Sher²,

Kavati

et al. 2018

allergy asthma proc

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“…Side effects of corticosteroids are well assessed in diseases such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, chronic idiopathic urticaria or asthma where oral predniso(lo)ne is frequently used. Yet, the relationship between corticosteroid dose and adverse events is not well quantified.…”

Section: Discussionmentioning

confidence: 99%

Adverse events related to low dose corticosteroids in autoimmune hepatitis

Brand

Veen

Lissenberg‐Witte

et al. 2019

Aliment Pharmacol Ther

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Summary Background Autoimmune hepatitis requires long‐term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long‐term studies are mainly derived from studies in rheumatic diseases. Aim To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long‐term maintenance treatment of patients with autoimmune hepatitis. Methods We retrospectively collected data on 476 patients (77% women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects. Results A total of 6634 years, with a median of 13 (range 1‐40) per patient were recorded. The median age at diagnosis was 44 years (range 2‐88). Adverse events were documented in 120 (25%) patients. Low‐dose predniso(lo)ne (0.1‐5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years. Conclusions Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses.

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“…Recent evidence has shown that shortterm use of corticosteroids is associated with a 2-to 5-fold increase in the incidence of acute adverse events, including sepsis, venous thromboembolism and fracture, compared with background rates. 33,34 Montelukast and ciclosporin were both used as add-on therapies before and after commencing omalizumab. Both of these treatments were previously recommended as third-line add-on therapies to H 1 -antihistamines during this study; however, montelukast is no longer recommended owing to the poor level of evidence for its efficacy, and ciclosporin is only recommended as standard therapy owing to not being licensed and its inferior safety profile compared with omalizumab.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis omalizumab treatment patterns in patients with chronic spontaneous urticaria: a real‐world study in Belgium

Lapeere

Baeck

Stockman

et al. 2019

Acad Dermatol Venereol

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Background Chronic spontaneous urticaria (CSU) is characterized by the repeated occurrence of persistent hives and/or angioedema for ≥6 weeks, without specific external stimuli. H 1-antihistamines have long been the standard of care of CSU, but many patients remain uncontrolled even at 49 the approved dose. Add-on therapy with omalizumab has proven effective in clinical trials, but little is known about omalizumab treatment in Belgium. Objective To collect real-world clinical data on omalizumab treatment in adults with CSU in Belgium. Methods This was an observational, retrospective chart review of adults with CSU, who initiated omalizumab treatment between August 2014 and December 2016 (maximum 28 months follow-up). Results In total, 235 patients were included (median time from symptom onset to diagnosis, 5.4 months; median time from diagnosis to commencing omalizumab, 6.7 months). Treatments used before/after commencing omalizumab did not always adhere to guidelines; many patients (26.4%/11.1%) received first-generation H 1-antihistamines, while 20.4% used omalizumab monotherapy after initiating treatment. The mean interval between omalizumab administrations was 4.8 (SD 1.7) weeks; 67.8% of patients had ≥1 interval prolongation and/or shortening. Mean baseline 7-day Urticaria Activity Score (UAS7) was 32.0 (SD 6.05); this improved to 12.6 (SD 11.2) after 1 month of omalizumab. About 67.2% of patients reached UAS7 ≤ 6 (well controlled) during the study. A total of 87 patients stopped omalizumab and never restarted before the end of the observation period; the most prevalent reason was remission of symptoms (49.4% of patients), followed by lack of effect (12.6%), lost to follow-up (6.9%) and adverse events (3.4%). Headache was the most common adverse event (n = 8/82). No anaphylaxis was reported. Conclusions This study revealed that patients initiated on omalizumab in Belgium had severe CSU at baseline, and showed substantial improvements after 1 month of treatment. Greater adherence to the prescription of guideline-recommended medications is needed for the treatment of CSU.

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Corticosteroid-related toxicity in patients with chronic idiopathic urticaria‐chronic spontaneous urticaria

Abstract: Patients with CIU/CSU who were treated with OCS had an increased risk of possible OCS-related side effects and higher total health care costs than their counterparts not treated with OCS.

Cited by 19 publications

References 19 publications

Real-world use of omalizumab in patients with chronic idiopathic/spontaneous urticaria in the United States

Real-world use of omalizumab in patients with chronic idiopathic/spontaneous urticaria in the United States

Adverse events related to low dose corticosteroids in autoimmune hepatitis

A retrospective analysis omalizumab treatment patterns in patients with chronic spontaneous urticaria: a real‐world study in Belgium

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