Clinical Remission of Chronic Spontaneous Urticaria (CSU): A Targeted Literature Review

Abstract

Introduction Chronic spontaneous (previously known as idiopathic) urticaria (CSU) is a chronic skin disease with the potential for natural remission. The objectives of this targeted literature review were to identify evidence on the clinical course of CSU, including remission rates, and to estimate cumulative remission rates for different time points. Methods Electronic databases (MEDLINE, MEDLINE-In Process, Embase, Web of Science, BIOSIS Previews and the Cochrane Library) and relevant conference proceedings were searched to identify studies involving patients with CSU aged ≥ 12 years that provide data on remission rates and disease duration. Observational studies with patient follow-ups of ≥ 1 year or review articles were included. Data extracted from five selected studies were used to run Kaplan–Meier (KM) analyses and best-fit distributions to calculate remission rates per 4-week period and weighted averages. Results Ten publications were included in this review. The proportion of patients achieving remission within year 1 ranged from 21 to 47%, while reported remission rate estimates at year 5 were 34% and 45%. Based on calculated 4-weekly remission rates, cumulative remission estimates ranged from 9 to 38% at year 1, from 29 to 71% at year 5 and from 52 to 93% at year 20. Cumulative weighted average estimates for the proportion of patients remitting at years 1, 5 and 20 were 17%, 45% and 73%, respectively. Conclusions Published evidence suggests that CSU is a self-limiting condition with variable disease severity and duration, apparently dependent on multiple factors. However, data sources differed in terms of definitions of disease severity and remission, as well as in conclusions on influencing factors. Further studies and uniform definitions are required. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00641-6.

Urticaria

“…The rates of progression of AU to CU are between 5% and 39% in most studies (see Supplementary Table 1). CSU is of shorter duration than CIndU, with a mean or median disease duration of ~1-4 years in most studies (see Supplementary Table 2), and the cumulative weighted average estimates for spontaneous remission at 1, 5 and 20 years are 17%, 45% and 73%, respectively 31 . CSU relapses in 6-31% of patients (see Supplementary Table 2).…”

Predicting Clinical Remission of Chronic Urticaria Using Random Survival Forests: Machine Learning Applied to Real-World Data

“…Some of the clinical variables identified by our model as important in predicting time to clinical remission have been previously reported in literature (e.g., older age at diagnosis, asthma, allergic rhinitis, and high BMI) [ 6 , 10 , 29 , 31 – 35 ]. However, there were other variables not identified by our model as important in predicting time to clinical remission but that, nonetheless, have been reported to be associated with time to clinical remission in other studies using different designs and target populations [ 34 , 35 ].…”

“…Published evidence suggests that patients with CU experience a wide range of cumulative remission rates ranging between 10% and 38% at 1 year and 30% and 71% at 5 years [ 6 ], and reach clinical remission at varying times with average disease duration between 3 and 5 years in adults [ 4 , 7 – 9 ]. Several demographic and clinical characteristics influencing the duration of active disease among patients with CU have been reported (e.g., age, gender, presence of angioedema, hypertension), although the data are limited and inconclusive for many reasons, such as variability in patient profiles, small sample sizes, and a lack of consensus on the definition of disease remission [ 8 – 10 ].…”

CRUSE®—An innovative mobile application for patient monitoring and management in chronic spontaneous urticaria

“…The signs and symptoms of CSU develop spontaneously, although drugs, infection 3 and high stress levels 4 can exacerbate the disease activity 5 . Many patients experience a protracted disease course that can last several years 1,6 . Due to its unpredictable nature, incapacitating symptoms, and associated comorbidities, CSU severely impairs patients' quality of life (QoL) and poses relevant economic impacts 7–10 .…”