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

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.

PMID: 38235261
PMCID: PMC10793168
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

Christine J Rubeiz et al. World Allergy Organ J. 2024.

. 2024 Jan 3;17(1):100858.

doi: 10.1016/j.waojou.2023.100858. eCollection 2024 Jan.

Authors

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.

PMID: 38235261
PMCID: PMC10793168
DOI: 10.1016/j.waojou.2023.100858

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.

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Figures

**Fig. 1**
Questionnaire Respondent's Countries of Origin (includes 4% response rate and above)

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

Affiliations

Abstract

Figures

References