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Chernyshov PV, Tomas-Aragones L, Zuberbier T, Kocatürk E, Manolache L, Pustisek N, Svensson Å, Marron SE, Sampogna F, Bewley A, Salavastru C, Koumaki D, Augustin M, Linder D, Abeni D, Salek SS, Szepietowski JC, Jemec GB. Quality of life measurement in assessing treatment effectiveness in urticaria: European experts position statement. Int J Dermatol 2024. [PMID: 38965063 DOI: 10.1111/ijd.17366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
In this study, the European Academy of Dermatology and Venereology (EADV) Task Forces on Quality of Life and Patient-Oriented Outcomes and Urticaria and Angioedema has examined the Health-Related Quality of Life (HRQoL) measurement in the treatment of urticaria. The Dermatology Life Quality Index was the most frequently used HRQoL instrument in clinical trials on urticaria. Many reports of clinical trials of urticaria gave no exact numeric results related to HRQoL changes, making clear conclusions and comparisons with other studies impossible. The interpretation of HRQoL impairment data is more difficult when assessed by instruments without severity stratification systems. The minimal clinically significant difference (MCID) is a more clinically oriented and relevant parameter than depending on statistically significant changes in HRQoL scores. Therefore, using HRQoL instruments with established MCID data in clinical trials and clinical practice is preferred.
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Affiliation(s)
| | | | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Emek Kocatürk
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | | | | | - Åke Svensson
- Department of Dermatology and Venereology, Skåne University Hospital, Malmö, Sweden
| | - Servando E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | | | - Anthony Bewley
- Barts Health NHS Trust, London, UK
- Queen Mary University, London, UK
| | - Carmen Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Dimitra Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dennis Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | | | - Sam S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
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2
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Thomsen SF, Pritzier EC, Anderson CD, Juvik S, Baust NV, Dodge R, Dahlborn AK, Vestergaard C. Treatment Patterns and Clinical Outcomes of Chronic Urticaria: Two-year Follow-up Results from the Scandinavian AWARE Study. Acta Derm Venereol 2022; 102:adv00689. [PMID: 35166853 PMCID: PMC9558753 DOI: 10.2340/actadv.v102.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) study investigated outcomes in patients with chronic urticaria refractory to H1-antihistamine. The objective of the current study was to analyse the effects of treatment on patients’ symptoms and quality of life for a period of up to 2 years. Over the 2 years, there was clear improvement in the high rates of disease burden from baseline, as evidenced by lower scores for disease severity scales, better quality of life, and a decreasing rate of medical resource utilization. However, this is the result of treatment adherence to the guidelines in highly specialized Scandinavian urticaria centres, and has its basis in the relatively low treatment intensity and control at enrolment. There is a need for greater adherence to the treatment guidelines and better management of antihistamine-refractory chronic urticaria.
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Affiliation(s)
| | | | | | | | | | | | | | - Christian Vestergaard
- Department of Dermatology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, DK-8200 Aarhus, Denmark.
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3
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Tharp MD, Bernstein JA, Kavati A, Ortiz B, MacDonald K, Denhaerynck K, Abraham I, Lee CS. Benefits and Harms of Omalizumab Treatment in Adolescent and Adult Patients With Chronic Idiopathic (Spontaneous) Urticaria: A Meta-analysis of "Real-world" Evidence. JAMA Dermatol 2019; 155:29-38. [PMID: 30427977 DOI: 10.1001/jamadermatol.2018.3447] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Omalizumab is indicated for the management of chronic idiopathic urticaria (CIU) (also known as chronic spontaneous urticaria) in adolescents and adults with persistent hives not controlled with antihistamines. The effectiveness of omalizumab in the real-world management of CIU is largely unknown. Objective To quantitatively synthesize what is known about the benefits and harms of omalizumab in the real-world clinical management of CIU regarding urticaria activity, treatment response, and adverse events. Data Sources Published observational studies (January 1, 2006, to January 1, 2018) and scientific abstracts on the effectiveness of omalizumab in CIU were identified using PubMed, Embase, Web of Science, and Cochrane search engines; references were searched to identify additional studies. Study Selection Included studies were observational in design and included at least 1 outcome in common with other studies and at a concurrent time point of exposure to omalizumab. A total of 67 articles (35.2% of those screened) were included in the analysis. Data Extraction and Synthesis PRISMA and MOOSE guidelines were followed; independent selection and data extraction were completed by 2 observers. Random-effects meta-analyses were performed. Main Outcomes and Measures Main outcomes were change in weekly Urticaria Activity Score (UAS7; range, 0-42), change in Urticaria Activity Score (UAS; range 0-6) (higher score indicating worse outcome in both scales), complete and partial response rates (percentages), and adverse event rate (percentage). Results Omalizumab therapy was associated with an improvement in UAS7 scores (-25.6 points, 95% CI, -28.2 to -23.0; P < .001; 15 studies, 294 patients), an improvement in UAS scores (-4.7 points, 95% CI, -5.0 to -4.4, P < .001; 10 studies, 1158 patients), an average complete response rate of 72.2% (95% CI, 66.1%-78.3%; P < .001; 45 studies, 1158 patients) with an additional average partial response rate of 17.8% (95% CI, 11.7%-23.9%; P < .001; 37 studies, 908 patients), and an average adverse event rate of 4.0% (95% CI, 1.0%-7.0%; P < .001; any level of severity, 47 studies, 1314 patients). Conclusions and Relevance Benefits and safety of omalizumab in the real-world treatment of CIU meet or exceed results gleaned from clinical trials. These real-world data on omalizumab in CIU may help inform both clinical treatment expectations and policy decision making.
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Affiliation(s)
- Michael D Tharp
- Department of Dermatology, Rush University Medical Center, Chicago, Illinois
| | - Jonathan A Bernstein
- Division of Immunology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Abhishek Kavati
- US Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Benjamin Ortiz
- Respiratory Medical Unit, US Clinical Development and Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Kris Denhaerynck
- Matrix45, Tucson, Arizona.,Department of Public Health, University of Basel, Basel, Switzerland
| | - Ivo Abraham
- Matrix45, Tucson, Arizona.,Associate Editor for Quantitative Methods.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona.,Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Christopher S Lee
- Matrix45, Tucson, Arizona.,Boston College Connell School of Nursing, Chestnut Hill, Massachusetts
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Cherrez-Ojeda I, Maurer M, Bernstein JA, Vanegas E, Felix M, Ramon GD, Ensina LF, Larco Sousa JI, Matos Benavides EE, Cardona Villa R, Latour Staffeld P, Morfin-Maciel BM, Mori J, Wilches C P, Mata VL, Cherrez A. Learnings from real-life experience of using omalizumab for chronic urticaria in Latin America. World Allergy Organ J 2019; 12:100011. [PMID: 30937137 PMCID: PMC6439401 DOI: 10.1016/j.waojou.2019.100011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/20/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background Updated urticaria guidelines recommend that patients should be assessed for disease activity, severity, control, and quality of life at baseline and follow up. Regarding treatment, guidelines consider second generation antihistamines as the cornerstone in therapy for chronic urticaria (CU), while other drugs, such as omalizumab, are conceived as second-line alternatives. In regards to omalizumab, despite advances in the management of CU, there are still open questions about timing, dosing, and objective measures for clinical response. This study was designed to portray the use of patient-reported outcomes (PROs) in chronic urticaria management, as well as the effectiveness and treatment patterns of omalizumab in CU, as seen in a real-life setting in Latin America. Methods This is a retrospective observational study, involving 72 Latin American patients with chronic urticaria treated with omalizumab. Patient reported outcomes and treatment patterns, response, quality of life improvement and discontinuation were analyzed. Results From the 72 patients, 91.7% (n = 66) were assessed through PROs, where urticaria control test (UCT) was the most used (79.2%; n = 57). Overall, 80.0% (n = 44) responded to omalizumab at some point of the treatment. Omalizumab 300 mg was associated with earlier response compared to lower doses. Regardless of dosage, most patients assessed with CU-Q2oL improved quality of life (80.8%; n = 21). With respect to omalizumab discontinuation, 20.8% (n = 15) patients interrupted omalizumab before the 3rd month of treatment (p = .000). Conclusions The present study highlights how the use of PROs and omalizumab in Latin America differ from guidelines' recommendations and clinical trials. Even though most patients were initiated under omalizumab 300 mg, most of them finished with lower doses. Regardless of dosage, most patients responded to omalizumab and improved quality of life at some point during treatment. However, such features were seen earlier with omalizumab 300 mg. Regarding treatment discontinuation, one-fifth of patients interrupted omalizumab before the third month.
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Key Words
- CU, chronic urticaria
- CU-Q2oL, chronic urticaria quality of life questionnaire
- Chronic spontaneous urticaria
- EAACI/GA2LEN/EDF/WAO, European Academy of Allergology and Clinical Immunology
- Global Allergy and Asthma European Network, European Dermatology Forum and World Allergy Organization
- LA, Latin America
- Latin America
- MCID, minimal clinical important difference
- Omalizumab
- PRO, patient-reported outcomes
- Patient-reported outcomes
- Quality of life
- SD, standard deviation
- UAS7, urticaria activity score 7
- UCT, urticaria control test
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
- Corresponding author. Iván Chérrez Ojeda, Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Samborondón, Ecuador. Código postal: 0901-952.
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan A. Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, United States
| | - Emanuel Vanegas
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - German D. Ramon
- Instituto de Alergia e Inmunología del Sur, Bahía Blanca, Prov. de Buenos Aires, Argentina
| | | | | | | | | | - P. Latour Staffeld
- Centro Avanzado de Alergia y Asma de Santo Domingo, Santo Domingo, Dominican Republic
- Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | | | | | - Paul Wilches C
- Unidad de Asma y Alergia del Hospital Monte Sinai, Cuenca, Ecuador
| | - Valeria L. Mata
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Annia Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
- University Hospital, Dermatology Department, Rostock, Germany
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Stepaniuk P, Vostretsova K, Kanani A. Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice. Allergy Asthma Clin Immunol 2018; 14:85. [PMID: 30574166 PMCID: PMC6299577 DOI: 10.1186/s13223-018-0310-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 12/11/2018] [Indexed: 01/15/2023] Open
Abstract
Background Cold-induced urticaria is a significant condition, especially among young females. Despite the morbidity of this disease, studies that fully characterize the disease are limited. Methods We analyzed the characteristics of patients diagnosed with cold-induced urticaria at a community-based allergy practice in Vancouver, BC, Canada between 2003 and 2016. Detailed patient history, diagnostic measures and treatment were evaluated. Results A total of 50 patients were found to have active cold-induced urticaria with a median age of 28.5 (range 2-67) years and 35 patients (70%) were female. 16 patients (32%) had co-occurring physical urticarias while 26 patients (52%) had secondary allergic diagnoses and 3 patients (6%) were thought to have a provoking factor. Of those with a clinical history of suspected cold-induced urticaria that were evaluated with ice cube testing, a positive test was obtained in 84.7% of patients. Treatment was largely with non-sedating antihistamines, with the majority of patients receiving this modality. Conclusions Cold-induced urticaria is a complex disease with significant overlap with other chronic inducible urticarias and other allergic diseases. Diagnostic testing shows inconsistent results and the mainstay of treatment consists of non-sedating antihistamines, with other options available for those who do not respond.
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Affiliation(s)
- Peter Stepaniuk
- 1Department of Internal Medicine, University of British Columbia, Vancouver, BC Canada.,2Division of Allergy and Immunology, University of British Columbia, Suite 207 - 3195 Granville Street, Vancouver, BC V5R 3V8 Canada
| | - Kateryna Vostretsova
- 2Division of Allergy and Immunology, University of British Columbia, Suite 207 - 3195 Granville Street, Vancouver, BC V5R 3V8 Canada
| | - Amin Kanani
- 2Division of Allergy and Immunology, University of British Columbia, Suite 207 - 3195 Granville Street, Vancouver, BC V5R 3V8 Canada
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Larenas-Linnemann DES, Parisi CAS, Ritchie C, Cardona-Villa R, Cherrez-Ojeda I, Cherrez A, Ensina LF, Garcia E, Medina IV, Rodríguez-González M, Caraballo JMS. Update on Omalizumab for Urticaria: What's New in the Literature from Mechanisms to Clinic. Curr Allergy Asthma Rep 2018; 18:33. [PMID: 29744661 DOI: 10.1007/s11882-018-0787-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Since omalizumab has been approved for urticaria, numerous randomized and real-life observational trials have been published. We reviewed the period January 2017-February 2018. RECENT FINDINGS Omalizumab is effective for the control of urticaria recalcitrant to antihistamines in different populations globally. The ratio of total serum IgE 4-week/baseline ≥2 can predict response with a high likelihood. In observational real-life trials, doses have been adjusted on an individual basis: in some populations, up to two-thirds of the patients can be controlled with 150 mg/month; however, others are still not controlled with 300 mg/month. In these, 150 mg bimonthly could be tried, before up-dosing to 450 mg/month. On the long run (up to 3 years) omalizumab kept its efficacy. In many patients, dosing intervals could be augmented (6-8 weeks, some even more). After a 12-month treatment, about 20% showed long-term remission without relapse. Some biomarkers are being detected. Adjusting omalizumab doses in urticaria patients could enhance efficacy (shortening dosing interval and/or augmenting dose) and save costs (after 12 months: extending dosing interval and/or reducing dose).
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Affiliation(s)
- Désirée E S Larenas-Linnemann
- Research Unit, Medica Sur Hospital and Clinical Foundation, Torre 2, cons.602, Puente de Piedra 150, Col. Toriello Guerra, Del. Tlalpan, 14050, México, D.F, Mexico.
| | | | | | - Ricardo Cardona-Villa
- Grupo de Alergología Clínica y Expermiental, IPS Universitaria, Universidad de Antioquia, Medellín, Colombia
| | | | - Annia Cherrez
- Respiralab Research Group, Guayaquil, Ecuador.,Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Luis Felipe Ensina
- Federal University of São Paulo, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Elizabeth Garcia
- Fundación Santa Fe de Bogotá - Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
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7
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Bernstein JA, Kavati A, Tharp MD, Ortiz B, MacDonald K, Denhaerynck K, Abraham I. Effectiveness of omalizumab in adolescent and adult patients with chronic idiopathic/spontaneous urticaria: a systematic review of 'real-world' evidence. Expert Opin Biol Ther 2018; 18:425-448. [PMID: 29431518 DOI: 10.1080/14712598.2018.1438406] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Chronic idiopathic/spontaneous urticaria (CIU/CSU) is a dermatological condition characterized by itchy wheals and/or angioedema of continuous or intermittent duration of ≥6 weeks with a high burden of disease and impact on quality of life. Omalizumab is a recombinant humanized monoclonal antibody that inhibits the binding of IgE to high affinity receptors, and is approved for the CIU/CSU indication. The objective of this systematic review was to evaluate and synthesize the evidence on the real-world effectiveness of omalizumab in CIU/CSU in daily clinical practice. AREAS COVERED This review of 84 observational effectiveness studies covers treatments (dosing, medication use), clinical outcomes (treatment response, disease activity, quality of life), and safety. EXPERT OPINION The clinical outcomes observed across studies underscore the real-world effectiveness of omalizumab in the management of CIU/CSU. Continued treatment may assist patients showing an initial response to achieve a complete treatment response. Response rates are aligned with observed changes in disease activity, symptom experience, and quality of life, and this across subtypes of CIU/CSU. The positive therapeutic profile is complemented by a positive safety profile. The real-world evidence summarized here points convincingly at the high degree of effectiveness of omalizumab in the treatment of CIU/CSU in daily clinical practice.
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Affiliation(s)
- Jonathan A Bernstein
- a Division of Immunology, Department of Internal Medicine , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Abhishek Kavati
- b US Health Economics & Outcomes Research , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - Michael D Tharp
- c Department of Dermatology , Rush University Medical Center , Chicago , IL , USA
| | - Benjamin Ortiz
- d US Clinical Development and Medical Affairs , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | | | - Ivo Abraham
- e Matrix45 , Tucson , AZ , USA
- f Department of Pharmacy Practice and Science, College of Pharmacy, Department of Family and Community Medicine , College of Medicine, University of Arizona , Tucson , AZ , USA
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