Translating Chronic Urticarial Guidelines to Clinical Practice: A Study Assessing How Allergists and Dermatologists Apply Guidelines Recommendations in Argentina

Máspero, Jorge; Stigliano, Ivan Daniel; Bianculli, Pablo; Molinas, Jorge; Ardusso, Ledit

doi:10.1016/j.jaci.2016.12.797

Cited by 4 publications

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“…Similarly, 41.9% of patients whose symptoms were uncontrolled with up‐dosed nsAH should have received further escalation to a third‐line treatment option. Such differences in treatments may be attributed to clinicians who do not always follow urticaria treatment guidelines and may require better acceptance of the guidelines for treatment 35‐37 . A web‐based survey of patients diagnosed with CU in Germany revealed that only 40% of symptomatic patients were under physician care, with the majority of them choosing to stop their consultations, as they felt doctors were unable to help them or that they knew how to treat the CU symptoms themselves 38 .…”

Section: Discussionmentioning

confidence: 99%

Antihistamine‐resistant chronic spontaneous urticaria remains undertreated: 2‐year data from the AWARE study

Maurer

Costa

Arnau

et al. 2020

Clin Experimental Allergy

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Background: Real-world evidence describing the benefits of recommended therapies and their impact on the quality of life (QoL) of chronic urticaria (CU) patients is limited. Objective: To investigate disease burden, current treatment schedule, and the use of clinical resources by patients with H 1-antihistamine-refractory CU in Europe. Methods: AWARE (A Worldwide Antihistamine-Refractory chronic urticaria patient Evaluation) is a global, prospective, non-interventional study in the real-world setting, sponsored by the manufacturer of omalizumab. Disease characteristics, pharmacological treatments, and health-related QoL of patients (N = 2727) ≥18 years of age diagnosed with H 1-antihistamine-refractory chronic spontaneous urticaria (without inducible urticaria) for >2 months are reported here. Results: Of the 2727 patients included, 1232 (45.2%) and 1278 (46.9%) were successfully followed up for any assessment and for the key outcome, the urticaria control test (UCT) score, respectively, and patients with complete remission (14.1%) were excluded from analyses.The proportion of patients with uncontrolled CSU (UCT score <12) dropped from 78% (n/N = 1641/2104) at baseline to 28.7% (n/N = 269/936) after two years of participation in the AWARE study. In addition, the proportion of patients with no impact of CSU on their QoL (assessed by the Dermatological Life Quality Index) increased to 57% (n/N = 664/1164) from 18.7% (n/N = 491/2621) at baseline. Emergency room visits (2.4% [n/N = 7/296] vs 33.5% [n/N = 779/2322]) and hospital stays (1.7% [n/N = 5/296] vs 24.2% [n/N = 561/2322]) reduced at Month 24 vs baseline. Overall, 23.2% (n/N = 26/112) patients on nonsedating H 1-antihistamines (nsAH) and 41.9% (n/N = 44/105) patients on up-dosed nsAH had uncontrolled CSU (UCT <12) at Month 24. In omalizumab-treated patients, 27.1% (n/N = 78/288) had uncontrolled CSU at Month 24. Conclusion: These data confirm improvements for most patients with CSU over a 2-year follow-up period. Further studies are needed to understand the differences between guideline recommendations and reported management. K E Y W O R D S angioedema, chronic spontaneous urticaria, quality of life, urticaria | 1167 MAURER Et Al.

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Section: Discussionmentioning

confidence: 99%

Antihistamine‐resistant chronic spontaneous urticaria remains undertreated: 2‐year data from the AWARE study

Maurer

Costa

Arnau

et al. 2020

Clin Experimental Allergy

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“…No data was collected on the attribution for lack of treatment, because it was unanticipated during study design that treatment rates would be so low. However, recent research suggests that clinicians are not always following urticaria treatment guidelines [ 17 , 20 , 42 ] and patients may have essentially ‘given up’ in favor of self-treatment or simply living with the condition [ 41 ]. Another possible reason for non-medication or non-escalation to third-line treatment could be the differences in coverage and payment for healthcare among EU and C/SA region.…”

Section: Discussionmentioning

confidence: 99%

Differences in chronic spontaneous urticaria between Europe and Central/South America: results of the multi-center real world AWARE study

Maurer

Houghton

Costa

et al. 2018

World Allergy Organization Journal

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BackgroundGlobal chronic urticaria (CU) disease experience and management is not well documented. This study descriptively compares these aspects among CU patients residing in Europe (EU) and Central and South America (C/SA).MethodsAWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is a global prospective, non-interventional study of CU in the real-world setting. Patients were ≥ 18 years with a diagnosis of H1-antihistamine-refractory CU for > 2 months. Differences between the EU and C/SA regions in demographic and clinical characteristics, quality of life (QoL), work and activity impairment, pharmacological treatment, and healthcare resource use were examined.ResultsIn total, 4224 patients were included in the analysis (C/SA 492; EU 3732). Rates of untreated patients were greater in the C/SA region (45.1% vs. 31.9%; P < 0.005) and escalation to third-line therapy was rare in both regions. Differences in disease experience emerged, with C/SA patients more commonly experiencing angioedema (C/SA 50.8% vs. EU 46.1%; P = 0.03) or comorbid chronic inducible urticaria (C/SA 30% vs. EU 22%; P < 0.001). Correspondingly, rates of uncontrolled urticaria were higher among C/SA patients (82.8% vs. 77.5%; P = 0.017) and patients in the C/SA region showed significantly greater work and activity impairment (absenteeism: 10.4 ± 19.7 vs. 6.7 ± 19.0, P = 0.004; presenteeism: 30.3 ± 31.9 vs. 24.4 ± 25.8, P = 0.001; work productivity loss: 33.9 ± 33.9 vs. 26.5 ± 27.5, P < 0.001; activity impairment: 37.7 ± 34.7 vs. 32.7 ± 30.1, P = 0.001). However, QoL impairment was greater in the EU region (Dermatology Life Quality Index: C/SA 6.5 ± 5.9 vs. EU 8.3 ± 7.0; P < 0.001). There was a significant difference in use of healthcare resources, including emergency services (39.6% vs. 29.3%; P < 0.001), hospitalization (7.7% vs 21.9%; P < 0.001) general practitioners (31.7% vs 57.3%; P < 0.001), and additional allergists or dermatologists (50.6% vs. 47.3%, P < 0.001), among patients in the C/SA and EU region, respectively. In both regions, patients with a primary diagnosis of CU with angioedema had significantly greater impairment in work and non-work activities and healthcare resource utilization compared to those without angioedema.ConclusionsThis study revealed that CU is a heterogeneous condition with differences in healthcare utilization and outcomes between EU and C/SA. However, overall there is a high unmet need of H1-antihistamine-refractory CU patients, which is associated with high use of healthcare resources, and has a large negative effect on QoL and work productivity.

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“…Available data suggest that adherence to guideline recommendations is poor, leading to an unmet need within the CU population. 5,[25][26][27][28][29] Furthermore, the majority of data on CU inadequately controlled with H 1 -antihistamines is limited to patient populations derived from specialized urticaria centres, which may not represent the general CU population due to limited numbers. 30,31 Results from this study confirmed these findings in Belgium, where treatments used prior to commencing and in combination with omalizumab did not always adhere to guidelines.…”

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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Translating Chronic Urticarial Guidelines to Clinical Practice: A Study Assessing How Allergists and Dermatologists Apply Guidelines Recommendations in Argentina

Cited by 4 publications

References 0 publications

Antihistamine‐resistant chronic spontaneous urticaria remains undertreated: 2‐year data from the AWARE study

Antihistamine‐resistant chronic spontaneous urticaria remains undertreated: 2‐year data from the AWARE study

Differences in chronic spontaneous urticaria between Europe and Central/South America: results of the multi-center real world AWARE study

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

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