Chronic spontaneous urticaria patients who are non-responsive to antihistamines have greater healthcare resource utilization and comorbidities at both baseline and follow-up assessment, which requires prompt management to control the disease more effectively, according to a newretrospective cohort study.
Chronic spontaneous urticaria (CSU) is a skin disorder associated with angioedema and wheals that persist for more than 6 weeks. The first-line treatment for CSU is a second-generation H1-antihistamine. In cases of insufficient symptom control, the guidelines recommend an increase in the dosage and/or adding another H1-antihistamine, an H2-antihistamine, a first-generation H1-antihistamine, a leukotriene receptor antagonist, or a first-generation H1-antihistamine at bedtime.
While H1-antihistamine is effective for CSU patients, approximately 50% of these patients are not responsive to these medications. This study aimed to investigate the disease burden and healthcare resource utilization and identify predictors associated with non-response to antihistamine treatment in CSU patients. The study findings are published in the World Allergy Organization Journal.
Baseline Characteristics
This retrospective cohort study included a total of 17,062 CSU patients, of which, 86.9% were non-responders and 13.1% were responders. The mean age of the study cohort at the index was 47.0 years, and most participants were females. The Charlson Comorbidity Index score was comparatively higher among non-responders, along with the prevalence of respiratory, atopic, depressive, and systemic diseases.
Hospital Resource Utilization Among Responders and Non-Responders
Responders and non-responders had increased specialist utilization at follow-up compared to the baseline at the time of follow-up. A greater proportion of non-responders had more than one visit to a dermatologist or allergist in the follow-up period.
Compared to responders, non-responders had greater all-cause and CSU-related inpatient admissions as well as all-cause and CSU-related outpatient visits per patient per year. During the follow-up period, all-cause and CSU-related healthcare resource utilization was higher among non-responders except for CSU-related outpatient visits, which were greater among responders.
Predictors of Non-Response to Antihistamines
Important predictors of non-response to H1-antihistamines include female sex, depression, chronic pulmonary diseases, types of specialist visits during the baseline period, and the therapeutic class of baseline treatments. The additional predictive factors are respiratory disease indicators, pain indicators, and pain and tenderness symptoms.
Source
Soong, W., Patil, D., Pivneva, I., Signorovitch, J., Wells, M. A., Balp, M., & Kuruvilla, M. (2023). Disease burden and predictors associated with non-response to antihistamine-based therapy in chronic spontaneous urticaria. World Allergy Organization Journal, 16(12), 100843. https://doi.org/10.1016/j.waojou.2023.100843
