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Chernyshov PV, Finlay AY, Tomas-Aragones L, Zuberbier T, Kocatürk E, Manolache L, Pustisek N, Svensson A, Marron SE, Sampogna F, Bewley A, Salavastru C, Koumaki D, Augustin M, Linder D, Abeni D, Salek SS, Szepietowski J, Jemec GB. Quality of life measurement in urticaria: Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient-Oriented Outcomes and Urticaria and Angioedema. J Eur Acad Dermatol Venereol 2024. [PMID: 38855825 DOI: 10.1111/jdv.20157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/03/2024] [Indexed: 06/11/2024]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces on quality of life (QoL) and patient-oriented outcomes and on urticaria and angioedema recommendations for the assessment of Health-related (HR) QoL in all patients with urticaria in research and practice are as follows: to use the DLQI for adults and the CDLQI for children as dermatology-specific and the CU-Q2oL as a disease-specific HRQoL instruments in urticaria; to use generic instruments to provide comparison of data on urticaria with non-dermatologic diseases, or to compare with healthy volunteers or the general population; to select validated HRQoL instruments with appropriate age limits; to present exact numeric data for HRQoL results; correct title of any HRQoL instrument should be used, along with its correct abbreviation and the reference to its original publication, where possible. The EADV TFs discourage the use of non-validated HRQoL instruments and modified HRQoL instruments that have not undergone standard validation.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - E Kocatürk
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - L Manolache
- Department of Dermatology, Dali Medical, Bucharest, Romania
| | - N Pustisek
- Children's Hospital Zagreb, Zagreb, Croatia
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - A Bewley
- Barts Health NHS Trust, London, UK
- Queen Mary University, London, UK
| | - C Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - D Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - S S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - J Szepietowski
- Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
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2
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Baudy A, Raison-Peyron N, Serrand C, Crépy MN, Du-Thanh A. Impact of Chronic Spontaneous or Inducible Urticaria on Occupational Activity. Acta Derm Venereol 2024; 104:adv36122. [PMID: 38551378 PMCID: PMC11000653 DOI: 10.2340/actadv.v104.36122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
The impact of chronic urticaria on work has been scarcely reported, whereas its peak incidence is between the ages of 20 and 40. The aim of this study was to assess the occupational impact of chronic urticaria and its treatment, by combining objective and patient-reported data. A monocentric observational study was performed using questionnaires over a 1-year period from 2021 to 2022 in chronic urticaria patients who were in a period of professional activity and agreed to participate. Of the 88 patients included, 55.7% assessed the occupational impact of their chronic urticaria as significant, and even more severe when chronic urticaria was poorly controlled. Some 86% of patients had symptoms at work, in a third of cases aggravated by work. However, occupational physical factors were not associated with an aggravation of inducible chronic urticaria. A total of 20% reported treatment-related adverse effects affecting their work. Despite low absenteeism, presenteeism and reduced productivity were important (> 20%). Six patients (6.8%) had difficulties keeping their work. For 72.7% of the patients, the occupational physician was not informed. The occupational impact of chronic urticaria should be discussed during consultations, particularly when it is insufficiently controlled. The occupational physician should be informed in order to support patients' professional project.
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Affiliation(s)
- Amandine Baudy
- Department of Dermatology, University Hospital of Montpellier, Montpellier, France; University of Montpellier, Montpellier, France
| | - Nadia Raison-Peyron
- Department of Dermatology, University Hospital of Montpellier, Montpellier, France
| | - Chris Serrand
- University of Montpellier, Montpellier, France; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nîmes university hospital, Nîmes, France
| | - Marie-Noëlle Crépy
- Department of Dermatology, University Hospital of Centre of Paris, Cochin Hospital, AP-HP, Paris, France; Department of Occupational and Environmental Diseases, University Hospital of Centre of Paris, Hotel-Dieu Hospital, AP-HP, Paris, France
| | - Aurélie Du-Thanh
- Department of Dermatology, University Hospital of Montpellier, Montpellier, France; University of Montpellier, Montpellier, France.
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Casale TB, Gimenez-Arnau AM, Bernstein JA, Holden M, Zuberbier T, Maurer M. Omalizumab for Patients with Chronic Spontaneous Urticaria: A Narrative Review of Current Status. Dermatol Ther (Heidelb) 2023; 13:2573-2588. [PMID: 37776480 PMCID: PMC10613187 DOI: 10.1007/s13555-023-01040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is a debilitating inflammatory disorder of the skin, characterized by a fluctuating natural history, a complex mechanism of action, and a significant burden on patients, including effect on quality of life, development of psychosocial disorders, and a range of comorbidities. Recent international guidelines recommend a therapeutic approach of first-line treatment with second generation H1-antihistamines and second-line treatment with the biologic omalizumab. Here, the salient aspects of CSU and current status of data for omalizumab for patients with CSU are reviewed, with a focus on mechanism of action, efficacy and real-world effectiveness (including patient outcomes, response, relapse, and remission), and safety (including consideration of the risk of anaphylaxis). The review also considers recent data on COVID-19, CSU, and omalizumab and presents our perspective on future needs. Overall, the data suggest that omalizumab is an effective and well-tolerated treatment for patients with CSU that provides benefits for a wide range of patients.
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Affiliation(s)
- Thomas B Casale
- Internal Medicine, Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, FL, 33620, USA.
| | | | - Jonathan A Bernstein
- Department of Medicine, Division of Immunology Allergy Section, University of Cincinnati, Cincinnati, OH, USA
| | | | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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4
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Patruno C, Fabbrocini G, Cillo F, Torta G, Stingeni L, Napolitano M. Chronic Urticaria in Older Adults: Treatment Considerations. Drugs Aging 2023; 40:165-177. [PMID: 36808569 DOI: 10.1007/s40266-023-01010-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/21/2023]
Abstract
Chronic urticaria is characterized by recurrent wheals and/or angioedema lasting for more than 6 weeks. Chronic urticaria is an extremely disabling disease limiting daily activities, compromising patient quality of life, and frequently associated with psychiatric comorbidities (depression and/or anxiety). Unfortunately, there are still gaps in the knowledge regarding treatment in special populations, especially in older patients. Indeed, there are no specific recommendations for the management and treatment of chronic urticaria in older people; therefore, recommendations for the general population are used. However, the utilization of some medications may be complicated by potential concerns of comorbidities or polypharmacy. Currently, the diagnostic and therapeutic procedures for chronic urticaria in the older patient are the same as those indicated for other age groups. In particular, there is a limited number of blood chemistry investigations for spontaneous chronic urticaria and specific tests for inducible urticaria. With regard to therapy, second-generation anti-H1 antihistamines are used and, in recalcitrant cases, omalizumab (an anti-IgE monoclonal antibody) and possibly cyclosporine A are additional choices. Nonetheless, it should be underlined that in older patients the differential diagnosis can be more difficult, owing to the lower frequency of chronic urticaria and the likelihood of other pathologies that are peculiar for this age group and that can be included in the chronic urticaria differential diagnosis. As far as therapy is concerned, the physiological characteristics of these patients, the possible comorbidities, and the intake of other medications often require a very attentive drug selection for chronic urticaria compared with other age groups. The purpose of this narrative review is to provide an update on the epidemiology, clinical characteristics, and management of chronic urticaria in older patients.
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Affiliation(s)
- Cataldo Patruno
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Cillo
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ginevra Torta
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
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5
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Abstract
Urticaria is an inflammatory skin disorder that affects up to 20% of the world population at some point during their life. It presents with wheals, angioedema or both due to activation and degranulation of skin mast cells and the release of histamine and other mediators. Most cases of urticaria are acute urticaria, which lasts ≤6 weeks and can be associated with infections or intake of drugs or foods. Chronic urticaria (CU) is either spontaneous or inducible, lasts >6 weeks and persists for >1 year in most patients. CU greatly affects patient quality of life, and is linked to psychiatric comorbidities and high healthcare costs. In contrast to chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) has definite and subtype-specific triggers that induce signs and symptoms. The pathogenesis of CSU consists of several interlinked events involving autoantibodies, complement and coagulation. The diagnosis of urticaria is clinical, but several tests can be performed to exclude differential diagnoses and identify underlying causes in CSU or triggers in CIndU. Current urticaria treatment aims at complete response, with a stepwise approach using second-generation H1 antihistamines, omalizumab and cyclosporine. Novel treatment approaches centre on targeting mediators, signalling pathways and receptors of mast cells and other immune cells. Further research should focus on defining disease endotypes and their biomarkers, identifying new treatment targets and developing improved therapies.
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Affiliation(s)
- Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| | - Ana M Giménez-Arnau
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Universitat Autònoma, Barcelona, Spain
| | - Kanokvalai Kulthanan
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jonny Peter
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Urticaria Center of Reference and Excellence (UCARE), Allergy and Immunology Unit, University of Cape Town, Lung Institute, Cape Town, South Africa
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
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Jalenques I, Bourlot F, Martinez E, Pereira B, D'Incan M, Lauron S, Rondepierre F. Prevalence and Odds of Anxiety Disorders and Anxiety Symptoms in Children and Adults with Psoriasis: Systematic Review and Meta-analysi. Acta Derm Venereol 2022; 102:adv00769. [DOI: 10.2340/actadv.v102.1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The magnitude of the association between psoriasis and depression has been evaluated, but not that between psoriasis and anxiety. The aim of this systematic review and meta-analysis was to examine the prevalence and odds of anxiety disorders and symptoms in patients with psoriasis. Five medical databases (Cochrane Database, EMBASE, PubMed, PsychINFO, ScienceDirect) were searched for relevant literature. A total of 101 eligible articles were identified. Meta-analysis revealed different prevalence rates depending on the type of anxiety disorder: 15% [95% confidence interval [CI] 9–21] for social anxiety disorder, 11% [9–14] for generalized anxiety disorder, and 9% [95% CI 8–10] for unspecified anxiety disorder. There were insufficient studies assessing other anxiety disorders to be able to draw any conclusions on their true prevalence. Meta-analysis also showed a high prevalence of anxiety symptoms (34% [95% CI 32–37]). Case-control studies showed a positive association between psoriasis and unspecified anxiety disorder (odds ratio 1.48 [1.18; 1.85]) and between psoriasis and anxiety symptoms (odds ratio 2.51 [2.02; 3.12]). All meta-analyses revealed an important heterogeneity, which could be explained in each case by methodological factors. The results of this study raise the necessity of screening for the presence of anxiety disorders, as previously recommended for depressive disorders, in patients with psoriasis and, if necessary, to refer such patients for evaluation by a mental health professional and appropriate treatment.
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7
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Kolkhir P, Muñoz M, Asero R, Ferrer M, Kocatürk E, Metz M, Xiang YK, Maurer M. Autoimmune chronic spontaneous urticaria. J Allergy Clin Immunol 2022; 149:1819-1831. [PMID: 35667749 DOI: 10.1016/j.jaci.2022.04.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/17/2022] [Accepted: 04/14/2022] [Indexed: 12/23/2022]
Abstract
Chronic spontaneous urticaria (CSU) is a debilitating mast cell-driven disease characterized by recurrent wheals and/or angioedema. Substantial progress has been made in dissecting the 2 main autoimmune mechanisms that drive the pathogenesis of CSU. Type I autoimmune (autoallergic) CSU is associated with IgE antibodies against autoantigens, for example, thyroid peroxidase and IL-24. Type IIb autoimmune CSU is mediated by autoantibodies that activate mast cells, for example, via IgE and FcεRI, and is present in less than 10% of patients with CSU when strict criteria are used, that is, triple positivity of autologous serum skin test, immunoassays for IgG autoantibodies, and basophil activation tests. A subpopulation of patients with CSU has both types. Type IIb autoimmune CSU is characterized by higher disease severity, concomitant autoimmune diseases, low levels of total IgE, elevated levels of IgG-anti-thyroid peroxidase, basopenia, eosinopenia, poor response to antihistamines and to omalizumab, and a good response to cyclosporine. Novel targeted therapies for CSU are under development such as ligelizumab, an anti-IgE, fenebrutinib and remibrutinib, Bruton's tyrosine kinase inhibitors, and dupilumab, an anti-IL-4Rα. Further studies should investigate the overlap between autoallergic and type IIb autoimmune CSU, optimize the diagnosis of both autoimmune endotypes using easy-to-perform, noninvasive, and inexpensive markers, and assess differences in response to therapy.
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Affiliation(s)
- Pavel Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; I.M. Sechenov First Moscow State Medical University (Sechenov University), Division of Immune-Mediated Skin Diseases, Moscow, Russia
| | - Melba Muñoz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica san Carlo, Paderno Dugnano, Italy
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra Pamplona (IDISNA), Spain, RETIC de Asma, Reacciones Adversas y Alérgicas, Madrid (ARADyAL), Spain, Madrid, Spain
| | - Emek Kocatürk
- Koç University School of Medicine, Department of Dermatology, Istanbul, Turkey
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Yi-Kui Xiang
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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Zheng Q, Zheng H, Zhou S, Shi Y, Zhang L, Xiao X, Zhang W, Zhou L, Huang Y, Chen M, Zhong F, Wang C, Li Y. Efficacy of acupuncture treatment for chronic spontaneous urticaria: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e045027. [PMID: 35105558 PMCID: PMC8808388 DOI: 10.1136/bmjopen-2020-045027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Chronic spontaneous urticaria (CSU) is a troublesome dermatological problem that can have a significant impact on quality of life. Previous studies have indicated that acupuncture may be beneficial for patients with CSU. However, well-designed studies determine the effects of acupuncture on CSU are rare. The aim of this study is to investigate the efficacy and safety of acupuncture treatment for patients with CSU. METHODS AND ANALYSIS This study is designed as a multicentre, parallel, three-arm, randomised, sham-controlled trial. A total of 330 patients diagnosed as CSU will be randomly allocated into three groups: the verum acupuncture group, the sham acupuncture group and the waiting-list control group in a 1:1:1 ratio. Patients in the verum and sham acupuncture groups will receive 16 treatment sessions over 4 weeks, while patients in the waiting-list control group will not receive any acupuncture treatment. The primary outcome is the changes of weekly urticaria activity scores at the end of treatment. Secondary outcomes include itching severity measurement, Dermatology Life Quality Index, Hamilton Depression Scale, Hamilton Anxiety Scale, Pittsburgh Sleep Quality Index and serum total IgE level. Adverse events will be recorded during the study observation period. All patients who are randomised in this study will be included in the intention-to-treat analysis. ETHICS AND DISSEMINATION Ethical approval of this study has been granted by the Sichuan Regional Ethics Review of Committee on Traditional Chinese Medicine (TCM) (ID: 2019 kl-006), the Medical Ethic Committee of the First Hospital of Wuhan (ID: (2019) number 7)) and the Medical Ethics Committee of the First Hospital of Hunan University of TCM (ID: HN-LLKY-2019-017-01/03) in three clinical centres in China, respectively. The results will be disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR1900022994.
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Affiliation(s)
- Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hui Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yunzhou Shi
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Leixiao Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xianjun Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Zhang
- Acupuncture, Tuina and Rehabilitation Department, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Li Zhou
- Department of Acupuncture and Moxibustion, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
| | - Ying Huang
- Dermatology Department, Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Mingling Chen
- Dermatology Department, Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Feng Zhong
- Acupuncture, Tuina and Rehabilitation Department, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Chuan Wang
- Department of Acupuncture and Moxibustion, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
| | - Ying Li
- Graduate School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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9
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Yuan Y, Xiao Y, Chen X, Li J, Shen M. A Systematic Review and Meta-Analysis of Health Utility Estimates in Chronic Spontaneous Urticaria. Front Med (Lausanne) 2021; 7:543290. [PMID: 33425930 PMCID: PMC7793814 DOI: 10.3389/fmed.2020.543290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Chronic spontaneous urticaria (CSU) is a common recurrent skin disease that adversely affect patient's quality of life condition to treat. Economic evaluations of health care often include patient preferences for health outcomes using utilities. Objectives: The study aimed to determine pooled estimates of utility-based quality of life in patients with CSU. Methods: We conducted a systematic review, meta-analysis, and meta-regression of peer-reviewed articles and conference papers that published from database inception to 31 April 2019 that reported utility estimates in patients with CSU. Scores reported with the EQ-5D, SF-6D, SF-12, and SF-36 instruments were converted to utilities using published mapping algorithms. Meta-analysis was used to calculate the pooled and meta-regression was used to examine the effects of possible factors. Results: The pooled utility estimate for CSU was 0.68 [95% confidence interval (CI): 0.67–0.70]. The pooled utility estimate that converted from SF-36 or SF-12 was 0.66 (95% CI: 0.58–0.74), 0.72 (95% CI: 0.70–0.74) for EQ-5D, and 0.65 (95% CI: 0.63–0.67) for SF-6D, respectively. According to the meta-regression, higher proportion of female patients was significantly associated lower utility estimates (p = 0.013). Conclusions: The study provides evidence-based utility estimates to inform health-related burden analysis of CSU and reference for the follow-up cost-effectiveness evaluation of chronic spontaneous urticaria intervention. These results highlight differences in common utility-based instruments and need to be cognizant of the specific instruments used when comparing the results of outcome studies.
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Affiliation(s)
- Yan Yuan
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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Savic S, Leeman L, El-Shanawany T, Ellis R, Gach JE, Marinho S, Wahie S, Sargur R, Bewley AP, Nakonechna A, Randall R, Fragkas N, Somenzi O, Marsland A. Chronic urticaria in the real-life clinical practice setting in the UK: results from the noninterventional multicentre AWARE study. Clin Exp Dermatol 2020; 45:1003-1010. [PMID: 32246853 DOI: 10.1111/ced.14230] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Chronic urticaria (CU) is a skin condition characterized by repeated occurrence of itchy weals and/or angio-oedema for > 6 weeks. AIM To provide data demonstrating the real-life burden of CU in the UK. METHODS This UK subset of the worldwide, prospective, noninterventional AWARE study included patients aged 18-75 years diagnosed with H1-antihistamine (H1-AH)-refractory chronic spontaneous urticaria (CSU) for > 2 months. Baseline characteristics, disease activity, treatments, comorbidities and healthcare resource use were documented. Quality of life (QoL), work productivity and activity impairment were assessed. RESULTS Baseline analysis included 252 UK patients. Mean age and body mass index were 45.0 years and 29.0 kg/m2 , respectively. Most patients were female (77.8%) and had moderate/severe disease activity (mean Urticaria Activity Score over 7 days was 18.4) and a 'spontaneous' component to their CU (73.4% CSU; 24.6% CSU and chronic inducible urticaria). Common comorbidities included depression/anxiety (24.6%), asthma (23.8%) and allergic rhinitis (12.7%). A previous treatment was recorded for 57.9% of patients. Mean Dermatology Life Quality Index score was 9.5, and patients reported impairments in work productivity and activity. Healthcare resource use was high. Severity of CSU was associated with female sex, obesity, anxiety and diagnosis. Only 28.5% of patients completed all nine study visits, limiting analysis of long-term treatment patterns and disease impact. CONCLUSIONS Adult H1-AH-refractory patients with CU in the UK reported high rates of healthcare resource use and impairment in QoL, work productivity and activity at baseline. The differing structures of UK healthcare may explain the high study discontinuation rates versus other countries.
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Affiliation(s)
- S Savic
- Department of Clinical Immunology and Allergy, St James's University Hospital, Leeds, UK
| | - L Leeman
- The Eden Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - T El-Shanawany
- Department of Immunology, University Hospital of Wales, Cardiff, UK
| | - R Ellis
- Department of Dermatology, James Cook University Hospital, Middlesbrough, UK
| | - J E Gach
- Department of Dermatology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - S Marinho
- The Allergy Centre, Wythenshawe Hospital, Manchester University Foundation Trust and University of Manchester, Manchester, UK
| | - S Wahie
- Department of Dermatology, University Hospital of North Durham, Durham, UK
| | - R Sargur
- Immunology and Allergy Unit, Sheffield Teaching Hospitals, Sheffield, UK
| | - A P Bewley
- Department of Dermatology, Whipps Cross Hospital and Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Nakonechna
- Clinical Immunology and Allergy Unit, Sheffield Teaching Hospitals, Sheffield, UK.,University of Liverpool, Liverpool, UK
| | - R Randall
- Respiratory and Inflammation, Novartis Pharmaceuticals UK Ltd, Camberley, Surrey, UK
| | - N Fragkas
- Respiratory and Inflammation, Novartis Pharmaceuticals UK Ltd, Camberley, Surrey, UK
| | - O Somenzi
- Respiratory and Inflammation, Novartis Pharmaceuticals UK Ltd, Camberley, Surrey, UK
| | - A Marsland
- Centre for Dermatology, Salford Royal Hospital, Salford, UK.,University of Manchester, Manchester, UK
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11
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Fricke J, Ávila G, Keller T, Weller K, Lau S, Maurer M, Zuberbier T, Keil T. Prevalence of chronic urticaria in children and adults across the globe: Systematic review with meta-analysis. Allergy 2020; 75:423-432. [PMID: 31494963 DOI: 10.1111/all.14037] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Urticaria is a frequent skin condition, but reliable prevalence estimates from population studies particularly of the chronic form are scarce. The objective of this study was to systematically evaluate and summarize the prevalence of chronic urticaria by evaluating population-based studies worldwide. METHODS We performed a systematic search in PUBMED and EMBASE for population-based studies of cross-sectional or cohort design and studies based on health insurance/system databases. Risk of bias was assessed using a specific tool for prevalence studies. For meta-analysis, we used a random effects model. RESULTS Eighteen studies were included in the systematic evaluation and 11 in the meta-analysis including data from over 86 000 000 participants. Risk of bias was mainly moderate, whereas the statistical heterogeneity (I2 ) between the studies was high. Asian studies combined showed a higher point prevalence of chronic urticaria (1.4%, 95%-CI 0.5-2.9) than those from Europe (0.5%, 0.2-1.0) and Northern American (0.1%, 0.1-0.1). Women were slightly more affected than men, whereas in children < 15 years we did not find a sex-specific difference in the prevalence. The four studies that examined time trends indicated an increasing prevalence of chronic urticaria over time. CONCLUSIONS On a global level, the prevalence of chronic urticaria showed considerable regional differences. There is a need to obtain more sex-specific population-based and standardized international data particularly for children and adolescents, different chronic urticaria subtypes and potential risk and protective factors.
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Affiliation(s)
- Julia Fricke
- Institute for Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Gabriela Ávila
- Institute for Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Institute of Medical Informatics, Biometry and Epidemiology (IBE) Ludwig‐Maximilians‐Universität Munich Munich Germany
| | - Theresa Keller
- Institute for Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Institute of Biometry and Clinical Epidemiology Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Karsten Weller
- Department of Dermatology and Allergy Comprehensive Allergy Centre Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Susanne Lau
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy Comprehensive Allergy Centre Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Comprehensive Allergy Centre Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Thomas Keil
- Institute for Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Institute of Clinical Epidemiology and Biometry University of Wuerzburg Wuerzburg Germany
- State Institute of Health Bavarian Health and Food Safety Authority Bad Kissingen Germany
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12
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Lee MS, Yoon J, Kim J, Shin YS, Park HS, Lee HY, Ye YM. Health-Related Utility of EQ-5D in Korean Adults With Chronic Urticaria: Mapping From Urticaria Outcome Measures. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:599-607. [PMID: 32400127 PMCID: PMC7225006 DOI: 10.4168/aair.2020.12.4.599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 01/12/2023]
Abstract
Purpose A need for useful measures reflective of the socio-economic burden of chronic urticaria (CU) has arisen. To obtain utility estimates for CU, we investigated EuroQol-5-Dimension (EQ-5D) indices according to urticaria control status and urticaria severity. Methods In this prospective observational study, we administered patient-oriented questionnaires on EQ-5D and urticaria outcomes, including Urticaria Activity Score over 7 days (UAS7), Urticaria Control Test (UCT), and CU-specific quality of life (CU-QOL). EQ-5D utility index scores were compared according to urticaria control status and disease severity. Conditional process analysis (CPA) was used to map EQ-5D utility scores from UAS7 and UCT. Results Greater EQ-5D utility values were obtained in patients with better urticaria control (0.91 ± 0.10 for well controlled CU, 0.84 ± 0.12 for partly controlled, 0.77 ± 0.14 for uncontrolled, P < 0.001). According to CU severity, mean utility values were ranged from 0.746 (severe, UAS7 ≥ 28) to 0.860 (moderate), 0.878 (mild), and 0.953 (urticaria free). CPA suggested that UAS7 was directly correlated with UCT (regression coefficient, −0.251; 95% confidence interval [CI], −0.278, −0.223; P < 0.001) and EQ-5D utility (−0.002; 95% CI, −0.003, −0.001; P = 0.007) after controlling for age, sex, urticaria duration, and combined allergic diseases. Conclusions EQ-5D values increased with improvement in urticaria control and decreased with urticaria severity. A predictive model mapping EQ-5D utility from UAS7 and UCT scores suggested that EQ-5D can be useful for the pharmacoeconomic evaluation of individualized treatments for CU patients.
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Affiliation(s)
- Min Sang Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jiwon Yoon
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Jiwoong Kim
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Young Lee
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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13
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Hopkinson K. The role of patient-reported outcomes in the management of chronic spontaneous urticaria. ACTA ACUST UNITED AC 2019; 28:144-150. [PMID: 30746981 DOI: 10.12968/bjon.2019.28.3.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic spontaneous urticaria (CSU) is a debilitating condition that can substantially affect patients' quality of life (QoL), mental health and ability to perform daily tasks. International guidelines on the management of CSU, jointly developed by the European Academy of Allergy and Clinical Immunology (EAACI), Global Allergy and Asthma European Network (GA2LEN), European Dermatology Forum (EDF) and World Allergy Organization (WAO), recommend a treat-to-target strategy until symptom control or remission is achieved. This may mean stepping up or down in the treatment algorithm according to the course of CSU and re-evaluating the need for continued/alternative drug treatment. Utilising patient-reported outcome (PRO) tools in daily clinical practice will create a gold standard for care in CSU, aiding the treat-to-target strategy, increasing patient wellbeing and reducing healthcare costs through optimal treatment and management of patients with CSU. This article outlines PRO tools recommended by EAACI/GA2LEN/EDF/WAO guidelines for assessment of CSU symptom control, severity and QoL.
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Affiliation(s)
- Kate Hopkinson
- Allergy Nurse Specialist, Department of Clinical Immunology and Allergy, Nottingham University Hospitals NHS Trust
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14
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Hoskin B, Ortiz B, Paknis B, Kavati A. Exploring the real-world profile of refractory and non-refractory chronic idiopathic urticaria in the USA: clinical burden and healthcare resource use. Curr Med Res Opin 2019; 35:1387-1395. [PMID: 30793986 DOI: 10.1080/03007995.2019.1586222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Chronic idiopathic/spontaneous urticaria (CIU/CSU) is a debilitating skin condition that is burdensome for patients and healthcare providers. We aimed to describe clinical characteristics, consultation patterns and healthcare resource utilization in real-world US patients with refractory and non-refractory CIU/CSU. Methods: Data was collected from the Adelphi Real World 2015 Urticaria Disease Specific Programme. Physicians completed patient record forms (PRFs) for the next four patients consulting with non-refractory CIU/CSU and the next six with refractory CIU/CSU; patients were considered refractory if symptomatic and on treatment step ≥2. The same patients were asked to complete patient self-completion (PSC) forms describing how CIU/CSU affected them. Results: Seventeen physicians (15 allergists; 2 dermatologists) completed 184 PRFs (108 refractory CIU/CSU; 76 non-refractory CIU/CSU); 140 patients completed PSC forms (93 refractory CIU/CSU; 47 non-refractory CIU/CSU). Mean time from first consultation to diagnosis was 13.5 (SD 28.3) weeks; mean time from diagnosis to first treatment was 16.0 (SD 37.9) weeks. Patients with refractory CIU/CSU were more likely to initially consult primary care physicians than those with non-refractory CIU/CSU (51% and 28%, respectively). The most common symptoms were itching, sleep problems and anxiety/distress, affecting 75%, 23% and 18%, respectively. Patient-perceived disease severity was greater than physician-perceived severity (refractory CIU/CSU kappa 0.1512; non-refractory CIU/CSU 0.1590). Conclusions: Patients with CIU/CSU in this real-world study - particularly those with refractory CIU/CSU - were slow to receive specialist care and had substantial symptom burdens; patient-physician perception of disease severity was discordant. Earlier diagnosis of CIU/CSU may lead to timely use of CIU/CSU therapies.
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Affiliation(s)
- Ben Hoskin
- a Adelphi Real World , Bollington Macclesfield , UK
| | - Benjamin Ortiz
- b Health Economics and Outcomes Research , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - Brandee Paknis
- b Health Economics and Outcomes Research , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - Abhishek Kavati
- b Health Economics and Outcomes Research , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
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15
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Zhang L, Xiao X, Hui R, Shi Y, Deng Y, Zheng H, Zheng Q, Zhou S, Yao J, Cao W, Liu Y, Hao P, Li Y. Autologous whole-blood or autologous serum acupoint injection therapy for chronic urticaria: A systematic review protocol. Medicine (Baltimore) 2019; 98:e16127. [PMID: 31232963 PMCID: PMC6636973 DOI: 10.1097/md.0000000000016127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Chronic urticaria (CU) is a common and easily recurring skin disease in the world. Many trials have shown that autologous whole-blood or autologous serum acupoint injection therapy is effective in treating CU. There is currently no systematic review of this therapy. The program aims to evaluate the effectiveness and safety of this therapy in patients with CU. METHODS Literature search will be conducted at Medline, PubMed, Excerpt Medica Database, Springer, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and other databases. The search date is until May 2019. We will search for popular terms including CU and this therapy. Import the literature electronically. Duplicate documents will be deleted. The primary outcome is the urticaria activity score or other validated scales. Secondary outcomes included response rate, quality of life scale, recurrence rate, and adverse events. A systematic review and search for a randomized controlled trial of this therapy for CU. Implement the Cochrane RevMan V5.3 bias assessment tool to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The mean difference, standard MD, and binary data will be used to represent continuous results. RESULTS This study will provide a comprehensive review of the available evidence for the treatment of CU with this therapy. CONCLUSION This study will provide new evidence for assessing the effectiveness and side effects of this therapy for CU. Since the data is not individualized, there is no need for formal ethical approval. PROSPERO REGISTRATION NUMBER CRD42019128364.
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Affiliation(s)
- Leixiao Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Xianjun Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
- The People's Hospital of Jianyang City, Jianyang
| | | | - Yunzhou Shi
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Yanli Deng
- Sichuan Second Chinese Medicine Hospital
| | - Hui Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Junpeng Yao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Wei Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Pingsheng Hao
- Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ying Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
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16
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Curto-Barredo L, Giménez-Arnau AM. Treatment of chronic spontaneous urticaria with an inadequate response to H1-antihistamine. GIORN ITAL DERMAT V 2019; 154:444-456. [PMID: 30717573 DOI: 10.23736/s0392-0488.19.06274-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The second-generation H1-antihistamines (sgAH) are the first-line symptomatic treatment of patients with chronic spontaneous urticaria (CSU). Up to 50% of the patients will not respond to licensed doses of sgAH. According to the guidelines, the dose of sgAH may be increased up to 4 times the conventional dose. However, even at higher doses, there is a subgroup of patients refractory to the antihistamine treatment. The purpose of this article was to review the different treatment options of antihistamine-refractory CSU patients. This revision examines the available literature for therapies used in chronic urticaria, including omalizumab, ciclosporin A, oral glucocorticoids, leukotriene receptor antagonists, H2 antihistamines, doxepin, dapsone, hydroxychloroquine, phototherapy, methotrexate, mycophenolate mofetil, azathioprine, autohemotherapy, intravenous immunoglobulins and rituximab, between others. After the exhaustive review of the medical literature only few high-quality studies have been identified, mostly for omalizumab. Omalizumab is an anti-immunoglobulin E monoclonal antibody, approved for the treatment of CSU, that has radically changed the management of the patients without good response to sgAH, allowing to reach complete responses in a high percentage of patients. Although actually the therapeutic management of CSU is more effective and safer than before 2014, there is place even for new and more effective treatments. A good number of partial responders and slow responders to omalizumab and a little percentage still of non-responders to available therapies stimulate the development of new drugs that will also be discussed.
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Affiliation(s)
- Laia Curto-Barredo
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain - .,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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17
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Hoskin B, Ortiz B, Paknis B, Kavati A. Humanistic Burden of Refractory and Nonrefractory Chronic Idiopathic Urticaria: A Real-world Study in the United States. Clin Ther 2018; 41:205-220. [PMID: 30606639 DOI: 10.1016/j.clinthera.2018.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/04/2018] [Accepted: 12/06/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Chronic idiopathic urticaria (CIU) is a debilitating skin condition that can profoundly affect patients' quality of life. This study explored the impact of refractory and nonrefractory CIU on patients in the real-world setting in the United States. METHODS Data were collected from the Adelphi Real World 2015 Urticaria Disease-Specific Programme. Physicians completed patient record forms (PRFs) for 4 consecutive patients consulting with nonrefractory CIU and 6 patients with refractory CIU. The PRF included information on patient characteristics, medication, and disease severity; physicians were asked about the impact of CIU on patients, and to rate their satisfaction with patients' treatment (scale, 1-7 [1 = extremely dissatisfied and 7 = extremely satisfied]). The same patients were asked to complete a patient self-completion form (PSC). This included questions regarding how CIU affected their everyday life and their satisfaction with and understanding of their condition and medications. The PSC included a number of patient-reported outcomes measures: the Dermatology Life Quality Index (scored from 0 to 30, with higher scores indicating greater impact), the Work Productivity and Activity Impairment (4 scores calculated [absenteeism, presenteeism, work productivity loss, and activity impairment], each scored from 0% to 100% after transformation, with higher scores indicating greater impairment), and the Jenkins Sleep Scale (assessed over 30 days; scored from 0 to 20, with higher scores indicating greater sleep disturbance). Completion of the PSC was voluntary. FINDINGS Seventeen physicians completed a total of 184 PRFs (108 for patients with refractory CIU; 76 for those with nonrefractory CIU); 140 of these 184 patients completed a PSC form (93 with refractory CIU; 47 with nonrefractory CIU). Overall, 26% of the entire population (30% of patients with refractory CIU and 17% with nonrefractory CIU) reported that skin symptoms had a great effect on their lives (Dermatology Life Quality Index score ≥11). Sleep problems were common: mean Jenkins Sleep Scale scores were 7.8 overall (8.1 for patients with refractory CIU and 7.2 for those with nonrefractory CIU). Overall work impairment was 19% in the overall population, with similar values in refractory and nonrefractory patients (18% and 20%, respectively). Physician satisfaction with disease control was not high, with physicians reporting a mean score of 4.8 on a 7-point scale. Twenty-one percent of patients were extremely dissatisfied, very dissatisfied, or dissatisfied with their treatment, and 52% believed better control could be achieved. IMPLICATIONS The humanistic burden of CIU is high. There is clearly a need for better management of CIU to improve outcomes for patients.
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Affiliation(s)
- Ben Hoskin
- Adelphi Real World, Bollington, Macclesfield, United Kingdom
| | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Brandee Paknis
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Abhishek Kavati
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States.
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18
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Maurer M, Abuzakouk M, Bérard F, Canonica W, Oude Elberink H, Giménez-Arnau A, Grattan C, Hollis K, Knulst A, Lacour JP, Lynde C, Marsland A, McBride D, Nakonechna A, Ortiz de Frutos J, Proctor C, Sussman G, Sweeney C, Tian H, Weller K, Wolin D, Balp MM. The burden of chronic spontaneous urticaria is substantial: Real-world evidence from ASSURE-CSU. Allergy 2017; 72:2005-2016. [PMID: 28543019 PMCID: PMC5724512 DOI: 10.1111/all.13209] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) can be debilitating, difficult to treat, and frustrating for patients and physicians. Real-world evidence for the burden of CSU is limited. The objective of this study was to document disease duration, treatment history, and disease activity, as well as impact on health-related quality of life (HRQoL) and work among patients with inadequately controlled CSU, and to describe its humanistic, societal, and economic burden. METHODS This international observational study assessed a cohort of 673 adult patients with CSU whose symptoms persisted for ≥12 months despite treatment. Demographics, disease characteristics, and healthcare resource use in the previous 12 months were collected from medical records. Patient-reported data on urticaria and angioedema symptoms, HRQoL, and work productivity and activity impairment were collected from a survey and a diary. RESULTS Almost 50% of patients had moderate-to-severe disease activity as reported by Urticaria Activity Score. Mean (SD) Dermatology Life Quality Index and Chronic Urticaria Quality of Life Questionnaire scores were 9.1 (6.62) and 33.6 (20.99), respectively. Chronic spontaneous urticaria markedly interfered with sleep and daily activities. Angioedema in the previous 12 months was reported by 66% of enrolled patients and significantly affected HRQoL. More than 20% of patients reported ≥1 hour per week of missed work; productivity impairment was 27%. These effects increased with increasing disease activity. Significant healthcare resources and costs were incurred to treat CSU. CONCLUSIONS Chronic spontaneous urticaria has considerable humanistic and economic impacts. Patients with greater disease activity and with angioedema experience greater HRQoL impairments.
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Affiliation(s)
- M. Maurer
- Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - F. Bérard
- Claude Bernard University Lyon; Lyon France
| | - W. Canonica
- IRCCS-Humanitas Research Hospital; Humanitas University; Rozzano-Milano Italy
| | | | | | | | - K. Hollis
- RTI Health Solutions; Research Triangle Park NC USA
| | - A. Knulst
- University Medical Center Utrecht; Utrecht The Netherlands
| | | | - C. Lynde
- Lynderm Research; Toronto ON Canada
| | - A. Marsland
- Salford Royal Hospital; University of Manchester; Salford UK
| | | | - A. Nakonechna
- Royal Liverpool and Broadgreen University Hospitals; Liverpool UK
| | | | - C. Proctor
- RTI Health Solutions; Research Triangle Park NC USA
| | - G. Sussman
- University of Toronto; Toronto ON Canada
| | - C. Sweeney
- RTI Health Solutions; Research Triangle Park NC USA
| | - H. Tian
- Novartis Pharmaceuticals Corporation; East Hanover NJ USA
| | - K. Weller
- Charité - Universitätsmedizin Berlin; Berlin Germany
| | - D. Wolin
- RTI Health Solutions; Research Triangle Park NC USA
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19
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Balp MM, Lopes da Silva N, Vietri J, Tian H, Ensina LF. The Burden of Chronic Urticaria from Brazilian Patients' Perspective. Dermatol Ther (Heidelb) 2017; 7:535-545. [PMID: 28748405 PMCID: PMC5698196 DOI: 10.1007/s13555-017-0191-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Chronic urticaria (CU), a proxy for chronic spontaneous urticaria, has been associated with a negative impact on health-related quality of life (HRQoL) and costs, but there is limited evidence on the burden of CU in Brazil. The objective of this study was to estimate the prevalence of CU and assess the burden of CU on HRQoL and healthcare resource utilization (HRU) among adults in Brazil. Methods This retrospective, cross-sectional study, pooled data from the 2011, 2012, and 2015 National Health and Wellness Survey in Brazil (n = 36,000). Respondents (aged ≥18 years) diagnosed with and treated for CU provided data on demographics, health history, HRQoL (mental and physical health status) on Short-Form SF-36v2, presence of psychological complaints, work impairment, activity impairment, and HRU. Generalized linear models, controlling for covariates, examined differences between those treated for CU and matched controls on the outcome variables. Results The prevalence of diagnosed CU was 0.41% (n = 249) and treated CU was 0.21% (n = 127). After adjustments, CU (currently treated for CU) was associated with worse mental functioning, physical functioning, and health utilities compared with controls (all p < 0.01). CU had over twice the odds of anxiety and sleep difficulties, over 1.5 times the work and activity impairment, twice the number of total physician visits, eight times the number of allergist visits, and twice the number of emergency room visits as controls (all p < 0.01). Conclusions Many CU patients using prescription treatment experienced anxiety and sleep disturbances, poorer HRQoL, significant work and activity impairment, and high HRU, compared with matched general population controls. Findings suggest an unmet need for more effective treatment and management of CU in Brazil. Funding Novartis Pharma AG and Genentech.
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Affiliation(s)
| | | | | | - Haijun Tian
- Novartis Pharmaceutical Corporation, Global Medical Affairs, East Hanover, NJ, USA
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Urticaria and Angioedema: an Update on Classification and Pathogenesis. Clin Rev Allergy Immunol 2017; 54:88-101. [DOI: 10.1007/s12016-017-8628-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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