Chronic spontaneous urticaria severity impacts disease burden, treatment satisfaction
Key takeaways:
- The impact of CSU on quality of life, sleep and work impairment differed based on disease severity.
- Full treatment satisfaction was mostly reported among those with mild CSU.
The severity of a patient’s chronic spontaneous urticaria impacted several outcomes, including quality of life and treatment satisfaction, according to results published in Annals of Allergy, Asthma and Immunology.
“Despite receiving treatment, many patients with [chronic spontaneous urticaria (CSU)] still experience clinical and humanistic burdens associated with their CSU symptoms that are proportionate with disease severity,” Giselle Mosnaim, MD, MS, allergist and immunologist in the division of allergy and immunology in the department of medicine at NorthShore University HealthSystem and clinical associate professor at the University of Chicago Pritzker School of Medicine, and colleagues wrote.
Using survey responses to questions related to CSU disease burden and treatment satisfaction, Mosnaim and colleagues assessed responses from 110 U.S. physicians and 474 matched patients with CSU to find out where there was agreement and disagreement between the two parties.
Dermatologists (n = 50) and allergists/immunologists (n = 40) made up most of the studied physicians, and the remaining 20 physicians belonged to primary care.
Both itching (66%) and hives (49%) were frequently reported symptoms seen by physicians in their patients. A history of angioedema was noted in nearly a quarter of patients (23%), according to the study.
When asked about moderate/severe current disease, researchers found more patients vs. physicians reporting this level of CSU severity (46% vs. 30%).
Researchers further observed that the impact of CSU on quality of life, sleep and work impairment differed based on disease severity, with significantly (P < .0001) poorer outcomes among those with physician-reported moderate/severe vs. mild disease:
- Dermatology Life Quality Index score (mean, 8.4 vs. 2.4);
- EuroQol 5 dimension score on vertical VAS (mean, 82.3 vs. 89.4);
- Jenkins Sleep Evaluation Questionnaire score (mean, 5.3 vs. 2.9); and
- Work Productivity and Activity Impairment overall score (mean, 33.4 vs. 9.1).
“Similar results were found when patients were grouped by patient-reported mild vs. moderate or severe CSU,” Mosnaim and colleagues wrote.
In terms of treatment satisfaction, full satisfaction — classified in the study as satisfaction with treatment and belief of best control achievement — was found in a similar proportion of physicians and patients (61% and 64%). Researchers noted that this level of satisfaction was mostly reported among those with mild CSU (physician-reported, 84%; patient-reported, 89%) rather than moderate CSU (physician-reported, 15%; patient-reported, 10%). Almost none of these patients had severe CSU (physician-reported, < 1%; patient-reported, 1%).
Of the physicians and patients failing to meet the criteria for full treatment satisfaction, the CSU severity level most often reported was severe (physician-reported, 92%; patient-reported, 78%), followed by moderate (physician-reported, 65%; patient-reported, 73%) and mild (physician-reported, 26%; patient-reported, 24%).
When comparing responses from patients with those from physicians, researchers reported agreement between the two groups on four factors: overall CSU severity (68%), itch severity (61%), hive severity (74%) and level of treatment satisfaction (79%).
Factors that differed between the two parties included reports of itching, hives, insomnia/sleep disturbance and painful/burning sensation (reported more by patients vs. physicians), as well as anxiety and depression (reported more by physicians vs. patients).
The study noted that three patient groups achieved high agreement on treatment satisfaction between patients and physicians. These included patients receiving omalizumab or other biologic treatment (87%), patients with mild CSU (82%) and patients with mild hive severity (80%).
Notably, the underreporting of CSU severity by physicians compared with patients was a common reason behind instances of disagreement on this factor, according to researchers.
“Although most patients and physicians agreed on symptom severity and treatment satisfaction, disagreement was largely due to physicians underreporting symptom severity relative to patient reporting,” Mosnaim and colleagues wrote.
Perspective
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These findings are not surprising as CSU has a significant burden on patient’s lives. In my experience, my patients come to me poorly controlled and express significant anxiety related to their hives. The itching and visible welts are problematic for patients. They impact work, leisure activity, interpersonal relationships and sleep.
Doctors can use these findings to improve care by recognizing the burden of hives to patients. Discuss treatment options and used shared decision-making principles to determine best treatment options for patients. Doctors should follow guidelines. I think this survey reflects the need for more education of health care professionals on how to treat hives, and we need more advanced therapeutics for patients that are poorly responsive to omalizumab.
Looking ahead, we need to establish a network of centers of excellence in the U.S. that can help educate and manage patients with difficult-to-treat CSU/angioedema.
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