Marcus Maurer1, Ulrike Raap2, Petra Staubach3, Grit Richter-Huhn4, Andrea Bauer5, Eva M Oppel6, Uwe Hillen7, Daniel Baeumer8, Maximilian Reinhardt8, Nadine Chapman-Rothe9. 1. Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany. 2. Department of Dermatology and Allergy, University of Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany. 3. Department of Dermatology, University Medical Center Mainz, Mainz, Germany. 4. Praxis für Hautkrankheiten, Dresden, Germany. 5. Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany. 6. Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany. 7. Department of Dermatology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany. 8. Novartis Pharma GmbH, Nuremberg, Germany. 9. Novartis Pharma AG, Basel, Switzerland.
Abstract
BACKGROUND: Previous reports indicate that patients with chronic spontaneous urticaria (CSU) are undertreated and that physicians show poor adherence to guideline recommendations. Awareness of CSU has improved in recent years, but it remains unclear if this has improved the management of these patients in clinical practice. OBJECTIVE: To describe disease burden, quality of life (QoL), and treatment patterns of patients with H1 -antihistamine-refractory CSU in Germany. METHOD: A World-wide Antihistamine-Refractory chronic urticaria (CU) patient Evaluation (AWARE) is a global prospective, non-interventional study of CU in the real-world setting, supported by the manufacturer of omalizumab. Patients (18-75 years) were included who had H1 -antihistamine-refractory CSU for ≥2 months. Disease characteristics, pharmacological treatments, and QoL (dermatology life quality index [DLQI], CU-QoL questionnaire, and angioedema QoL questionnaire) are reported for patients enrolled in Germany. RESULTS: After 1 year in AWARE, CSU remained uncontrolled (urticaria control test [UCT] score <12) in 432 of 1032 (42.2%) patients. QoL impairment remained high after 1 year, with 28.2% of patients reporting that CSU had a moderate/very large/extremely large effect on the DLQI. Most patients did not receive guideline-recommended treatments at the end of the 1-year observation period. Changes in treatments were most evident at the first patient visit, with an increase in patients receiving omalizumab vs prior therapy from 8.5% to 21.4%, and a decrease in those receiving no treatment from 29.9% to 12.8%. These changes were associated with reduced hives, angioedema, UCT scores, and QoL scores at Month 3, but only modest improvements thereafter. Of 528 patients with uncontrolled CSU and who were eligible for treatment escalation, only 3% received up-dosing of H1 -antihistamines and only 5% were initiated on omalizumab during 1 year of treatment. CONCLUSIONS & CLINICAL RELEVANCE: This study highlights a significant discrepancy between recommendations for managing CSU in international guidelines, and in real-world clinical practice in Germany.
BACKGROUND: Previous reports indicate that patients with chronic spontaneous urticaria (CSU) are undertreated and that physicians show poor adherence to guideline recommendations. Awareness of CSU has improved in recent years, but it remains unclear if this has improved the management of these patients in clinical practice. OBJECTIVE: To describe disease burden, quality of life (QoL), and treatment patterns of patients with H1 -antihistamine-refractory CSU in Germany. METHOD: A World-wide Antihistamine-Refractory chronic urticaria (CU) patient Evaluation (AWARE) is a global prospective, non-interventional study of CU in the real-world setting, supported by the manufacturer of omalizumab. Patients (18-75 years) were included who had H1 -antihistamine-refractory CSU for ≥2 months. Disease characteristics, pharmacological treatments, and QoL (dermatology life quality index [DLQI], CU-QoL questionnaire, and angioedema QoL questionnaire) are reported for patients enrolled in Germany. RESULTS: After 1 year in AWARE, CSU remained uncontrolled (urticaria control test [UCT] score <12) in 432 of 1032 (42.2%) patients. QoL impairment remained high after 1 year, with 28.2% of patients reporting that CSU had a moderate/very large/extremely large effect on the DLQI. Most patients did not receive guideline-recommended treatments at the end of the 1-year observation period. Changes in treatments were most evident at the first patient visit, with an increase in patients receiving omalizumab vs prior therapy from 8.5% to 21.4%, and a decrease in those receiving no treatment from 29.9% to 12.8%. These changes were associated with reduced hives, angioedema, UCT scores, and QoL scores at Month 3, but only modest improvements thereafter. Of 528 patients with uncontrolled CSU and who were eligible for treatment escalation, only 3% received up-dosing of H1 -antihistamines and only 5% were initiated on omalizumab during 1 year of treatment. CONCLUSIONS & CLINICAL RELEVANCE: This study highlights a significant discrepancy between recommendations for managing CSU in international guidelines, and in real-world clinical practice in Germany.
Authors: Marcus Maurer; Ana Giménez-Arnau; Luis Felipe Ensina; Chia-Yu Chu; Xavier Jaumont; Paolo Tassinari Journal: World Allergy Organ J Date: 2020-09-12 Impact factor: 4.084
Authors: Andrea Bauer; Heinrich Dickel; Thilo Jakob; Andreas Kleinheinz; Undine Lippert; Martin Metz; Sibylle Schliemann; Uwe Schwichtenberg; Petra Staubach; Eva Valesky; Nicola Wagner; Bettina Wedi; Marcus Maurer Journal: Allergo J Date: 2021-03-26