Complete Treatment Response Improves Sleep, HRQOL in Chronic Spontaneous Urticaria

Study data published in the Journal of Allergy and Clinical Immunology: In Practice demonstrate the positive effects of complete treatment response in patients with chronic spontaneous urticaria (CSU). In a large cohort of patients with CSU, disease control was strongly correlated with improved sleep and health-related quality of life (HRQOL).

To assess the real-world benefits of treatment for CSU, investigators extracted data from the Chronic Urticaria Registry (CURE), an observational cohort of patients with CSU from around the world. The registry captures demographic and clinical data collected by questionnaire at 6-month intervals. Patient response to treatment was assessed using the urticaria control test (UCT), weekly Urticaria Activity Score (UAS7), and physician global assessment (PhyGA). The proportions of patients with complete response to treatment (as reflected by a UAS7 of 0 [UAS7=0]), complete control of disease (reflected by a UCT score of 16 [UCT=16]), and complete response per physician assessment (PhyGA=CR) were calculated. Sleep and overall health quality were assessed using the Chronic Urticaria Quality of Life Questionnaire, with the Dermatology Life Quality Index contributing to assessment of health quality. Sleep and quality of life outcomes were compared across treatment response categories. 

The study cohort comprised 2078 patients, among whom 27.6% were men. Median age was 43 years (interquartile range, 32-56). Current treatment consisted of second-generation antihistamines, omalizumab, cyclosporine, and other treatments.

At baseline, 9.8%, 17.9% and 42.3% of patients had a UCT of 16, a UAS7 of 0, and PhyGA=CR, respectively. These proportions increased at the 6-month and 12-month follow-up assessments. Patients with complete control of disease and complete response to treatment reported better sleep and HRQOL than patients who did not. Similarly, patients with PhyGA=CR reported less impairment in HRQOL compared with patients with partial or nonresponse on PhyGA.

At baseline, complete control of disease (UCT=16) was strongly associated with the presence of angioedema without wheals (P =.003), male sex (P =.006), and treatment with omalizumab (P <.001). Among the 469 patients who achieved complete control or complete response, 16.4% showed response on all 3 instruments. Agreement was moderate between UCT=16 and UAS7=0 measurements but poor between UCT=16 and PhyGA.

Results from this study emphasize the importance of disease control in patients with CSU. “Only by achieving complete or nearly [complete control] of their CSU could patients fully eliminate negative impacts on their sleep and [quality of life], which supports the … guideline-recommended treatment aim of achieving complete resolution of the disease,” investigators wrote. “Further, patient-reported outcomes demonstrate a more accurate measurement of the CSU disease status and of the true impact of CSU on the patients’ lives compared with physician assessments; therefore, these should be used wherever possible.”

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.