Analysis of questionnaire survey to determine worldwide trends in prescriptions of biologics for the treatment of unresponsive chronic urticaria

Christine J Rubeiz; Ricardo Asero; Stephen Betschel; Timothy Craig; Anete Grumach; Michihiro Hide; David Lang; Michael Levin; Hilary Longhurst; Eli Magan; Marcus Maurer; Romi Saini; Gordon Sussman; Elias Toubi; Dinh Nguyen Van; Torsten Zuberier; Jonathan A Bernstein

doi:10.1016/j.waojou.2023.100858

Analysis of questionnaire survey to determine worldwide trends in prescriptions of biologics for the treatment of unresponsive chronic urticaria

World Allergy Organ J. 2024 Jan 3;17(1):100858. doi: 10.1016/j.waojou.2023.100858. eCollection 2024 Jan.

Authors

Christine J Rubeiz¹, Ricardo Asero², Stephen Betschel³, Timothy Craig⁴, Anete Grumach⁵, Michihiro Hide⁶, David Lang⁷, Michael Levin⁸, Hilary Longhurst^{9

10}, Eli Magan¹¹, Marcus Maurer¹², Romi Saini¹³, Gordon Sussman¹⁴, Elias Toubi¹⁵, Dinh Nguyen Van^{16

17

18}, Torsten Zuberier^{19

20}, Jonathan A Bernstein^{1

21}

Affiliations

¹ Cincinnati Children's Hospital Medical Center, Division of Allergy and Immunology, Cincinnati, OH, USA.
² Ambulatorio di Allergologia, Clinica San Carlo, Pademo Dugnano, Italy.
³ Unity Health, St Michael's Hospital, University of Toronto, Ontario, Canada.
⁴ Pediatrics and Biomedical Sciences, Penn State University, Hershey, PA, USA.
⁵ Centro Universitário Faculdade de Medicina ABC, Brazil.
⁶ Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
⁷ Cleveland Clinic Lerner College of Medicine, Department of Allergy and Clinical Immunology, Cleveland, OH, USA.
⁸ University of Cape Town, South Africa.
⁹ Department of Medicine, University of Auckland, Te Toka Tumai, New Zealand.
¹⁰ Department of Immunology, Auckland City Hospital, Te Toka Tumai, New Zealand.
¹¹ Assuta Ashdod University Medical Center, Ben Gurion University of the Negev, Israel.
¹² Charité and Fraunhofer, Berlin, Germany.
¹³ Johns Hopkins University School of Medicine, USA.
¹⁴ University of Ontario, Canada.
¹⁵ University of Haifa, Israel.
¹⁶ Vinmec Health Care System, China.
¹⁷ College of Health Sciences, Vin University, China.
¹⁸ Department of Medicine, College of Medicine, Penn State University, USA.
¹⁹ Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.
²⁰ Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
²¹ University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Cincinnati, OH, USA.

Abstract

Background: Chronic spontaneous urticaria (CSU) is a common condition treated by allergist/immunologists, but the only FDA-approved biologic medication, omalizumab, may be underutilized globally.

Objective: This study was performed to determine the global prescription of omalizumab for treatment of CSU by allergists/immunologists.

Methods: Anonymous questionnaire surveys were distributed online to World Allergy Organization (WAO) members worldwide. Categorical data were analyzed for descriptive analysis using one-way frequency tabulation in SAS 9.4.

Results: There were 348 respondents (43 missing data); Average age 51 (range 28-90); M/F 48%/52%. 58% had > 15 years of clinical experience and 10% < 5; 42% worked in private clinics, 36% public hospitals, 24% academia, 18% private hospitals, and 4% in community practice. Eighty-two percent (82%) prescribed omalizumab for CSU patients and use of omalizumab was highest among young practitioners. The most significant barriers were cost (63%) and restricted formulary (24%). Drug safety (63%) and chances of adverse events (47%) were the most significant factors deciding treatment. Twenty-two percent (22%) reported 80-100% of CSU patients were complete responders to omalizumab; 34% preferred increasing frequency (q 2-weeks), and 18% preferred increasing dose (600 mg q 4-weeks) for partial or non-responders. UAS7, UCT, and CU-QoL were used to assess CSU by 55%, 29%, and 25% of respondents, respectively. Autoimmune thyroid disease (62%), thyroid abnormality (43%) and allergic rhinitis (35%) were the most frequent comorbidities reported.

Conclusions: Most clinicians favored omalizumab over other potential treatments due to safety. Although younger clinicians were more likely to prescribe omalizumab, cost and formulary access were major barriers. Only 22% of respondents reported 80% or greater of their patients had complete response to omalizumab, indicating the need for novel CSU therapies.

Keywords: Adverse effects; Alternative therapy; Biologics; Chronic spontaneous urticaria; Clinical research; Epidemiology; H1-antihistamines; Monitoring; Practice management; Safety.