Dissatisfaction in CSU management
Treating chronic spontaneous urticaria (CSU) often means managing uncontrolled symptoms and unsatisfied patients.1
~50% of patients with CSU remain symptomatic despite treatment2
First-line treatment with antihistamines resolves symptoms for about half of patients with CSU.2 But when patients have unresolved symptoms, health care providers (HCPs) find themselves with limited options.3
Repeated antihistamine trials can prolong patient distress
Expert consensus recommends second-generation antihistamines as the first step for treating CSU and to increase the dose if symptoms persist3
After 2 to 4 weeks of persistent CSU symptoms on antihistamine treatment, there's no evidence that continuing antihistamines alone will have a beneficial effect3,4
In a retrospective survey study, symptomatic patients diagnosed with CSU often stayed on the standard dose of antihistamines for up to a full year despite being refractory to this treatment4,*
Oral steroids are not intended for long-term use
Acute steroid use does not provide any long-term benefit for CSU, and it may introduce additional safety risks3
For these reasons, urticaria treatment guidelines† strongly advise against the prolonged use of steroids3
In a retrospective study of ~12,000 patients in the US with CSU, 55.4% were treated with oral corticosteroids and the average exposure was 29.3 days6,‡
OCS=oral corticosteroids.
*This real-world study assessed the disease burden, quality of life, and treatment patterns in 1032 patients who had H1–antihistamine-refractory CSU for ≥2 months.4
†The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria.3
‡This US-based real-world study analyzed a commercial claims database to investigate the relationship between OCS use and the risk of developing side effects in 12,647 patients with CSU.6
<20% of patients with CSU who are symptomatic on antihistamines receive an advanced therapy4
When patients remain symptomatic on increased doses of antihistamines, there are few additional treatment options, creating a treatment gap in CSU3
CSU is driven by internal mechanisms rather than external factors.2
References:
1. Mehlis S, Patil D, Wells MA, et al. Poster presented at: American Academy of Dermatology Annual Meeting 2023; March 17–21, 2023; New Orleans, LA.
2. Kaplan A, Lebwohl M, Giménez-Arnau AM, Hide M, Armstrong AW, Maurer M. Allergy. 2023;78(2):389–401. doi:10.1111/all.15603
3. Zuberbier T, Latiff AHA, Abuzakouk M, et al. Allergy. 2022;77(3):734–766. doi:10.1111/all.15090
4. Maurer M, Raap U, Staubach P, et al. Clin Exp Allergy. 2019;49(5):655–662. doi:10.1111/cea.13309
5. Goldstein S, Eftekhari S, Mitchell L, et al. Acta Derm Venereol. 2019;99(12):1091–1098. doi:10.2340/00015555-3282
6. Ledford D, Broder MS, Antonova E, Omachi TA, Chang E, Luskin A. Allergy Asthma Proc. 2016;37(6):458–465. doi:10.2500/aap.2016.37.3999