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. 2025 Nov;15(11):e70110.
doi: 10.1002/clt2.70110.

Key Predictors of Adherence to a Mobile Health App for Managing Chronic Spontaneous Urticaria

Hugo Viegas  1   2 Bernardo Sousa-Pinto  1   2 Rafael José Vieira  1   2 Aiste Ramanauskaite  3   4 Ellen Witte-Händel  3   4 Ana Gimenez-Arnau  5 Carole Guillet  6 Claudio Alberto Salvador Parisi  7 Constance Katelaris  8 Daria Fomina  9   10   11 Désirée Larenas-Linnemann  12 Jorge Sánchez  13 Elizabeth Garcia  14 Hermenio Lima  15 Igor Kaidashev  16 Iman Nasr  17 Isabel Ogueta Canales  18   19   20 Ivan Cherrez-Ojeda  3   4   21 Jean Bousquet  3   4 Jonathan A Bernstein  22 Jonny Peter  23 Jose Ignacio Larco Sousa  24 Kanokvalai Kulthanan  25 Karsten Weller  3   4 Kiran Godse  26 Krzysztof Rutkowski  27 Lasma Lapina  28 Laurence Bouillet  29 Luis Felipe Ensina  30 Margarida Gonçalo  31 Maria Staevska  32 Mariam Ali Yousuf Al-Nesf  33 Markus Magerl  3   4 Martin Metz  3   4 Martijn van Doorn  34 Mary Anne Castor  35 Maryam Khoshkhui  36 Michael Makris  37 Michihiro Hide  38 Mohamad Abuzakouk  39 Mona Al-Ahmad  40 Murat Türk  41 Natasa Teovska Mitrevska  42 Niall Conlon  43 Nicole Nojarov  3   4 Pavel Kolkhir  3   4 Philip Li  44 Ramzy Mohammed Ali  33 Rand Arnaout  45 Riccardo Asero  46 Sabine Altrichter  3   4   47   48 Simon Francis Thomsen  49 Young-Min Ye  50 Zenon Brzoza  51 Zuotao Zhao  52 Torsten Zuberbier  3   4 Frank Siebenhaar  3   4 Emek Kocatürk  3   4   53 Sophia Neisinger  3   4
Affiliations

Key Predictors of Adherence to a Mobile Health App for Managing Chronic Spontaneous Urticaria

Hugo Viegas et al. Clin Transl Allergy. 2025 Nov.

Abstract

Background: Mobile health technologies may improve the management of chronic diseases, such as chronic spontaneous urticaria. However, effectiveness of mHealth tools largely depends on patient adherence, which can be influenced by various demographic, clinical, behavioural, psychosocial factors, and apps characteristics (appealing and simplicity of use). Understanding these adherence patterns is crucial for optimizing mHealth interventions. In this study, we aimed to assess adherence patterns associated to the use of CRUSE, a mHealth app designed for patients with CSU.

Methods: We assessed users of the CRUSE app with self-reported CSU or suggested by a physician. For each user, we evaluated the number of days they completed the CRUSE daily monitoring questionnaire (app adherence) within the first 3 months after installation. We constructed univariable and multivariable ordered beta regression models to identify predictors of 3-month adherence to the app.

Results: We analysed data from 2085 patients (66,114 days). Median adherence to the CRUSE app was of 22 days (24.4% of 90 days). In multivariable regression models, the variables more strongly associated with increased adherence to CRUSE included age (average increase = 0.16 percent points [pp] per additional year; 95% credible interval [CrI] = 0.08; 0.23 pp), male sex (average difference = 4.24 pp; 95% CrI = 1.77; 6.39 pp), being from a European country (average difference = 2.66 pp; 95% CrI = 0.59; 5.19 pp), and using monoclonal antibodies (average difference = 4.60 pp; 95% CrI = 2.26; 6.65 pp).

Conclusions: Our findings suggest that age, male sex, residence in Europe, and the use of monoclonal antibodies are significant factors associated with increased adherence to the CRUSE app. These insights may help identify patient subgroups who would benefit most from mHealth support in managing CSU.

Keywords: adherence; chronic spontaneous urticaria; mHealth.

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Conflict of interest statement

Hugo Viegas has no conflict of interest to declare in relation to this work.

Bernardo Sousa‐Pinto has no conflict of interest to declare in relation to this work.

Rafael José Vieira has no conflict of interest to declare in relation to this work.

Aiste Ramanauskaite has no conflict of interest to declare in relation to this work.

Ellen Witte‐Händel has no conflict of interest to declare in relation to this work.

Ana Gimenez‐Arnau has received consulting fees from Almirall, Amgen, Blue ‐Print, CELLDEX, ESCIENT, FAES, Genentech, GSK, Jaspers, Leo Pharma, Mitsubishi Tanabe, Novartis, Noucor, Sanofi–Regeneron, Thermo Fisher Scientific, Septerna, Servier, Uriach Pharma, grants or contracts with ESCIENT, NOUCOR, Novartis, Instituto Carlos III‐ FEDER, Uriach Pharma and Payments or honoraria for lectures from Almirall, Avene, Genentech, GSK, LEO‐PHARMA, Menarini, MSD, NOUCOR, Novartis, Sanofi, Uriach Pharma.

Carole Guillet has no conflict of interest to declare in relation to this work.

Claudio Alberto Parisi has no conflict of interest to declare in relation to this work.

Constance Katelaris has no conflict of interest to declare in relation to this work.

Daria Fomina has no conflict of interest to declare in relation to this work.

Désirée Larenas‐Linnemann Fomina has no conflict of interest to declare in relation to this work. Outside she declares payment to her centre for lectures from AZ, GSK, Sanofi, Novartis, and Chiesi.

Jorge Sánchez Fomina has no conflict of interest to declare in relation to this work.

Elizabeth Garcia has no conflict of interest to declare in relation to this work.

Hermenio Lima reports consultancy fees from AbbVie (Abbott), Amgen, AstraZeneca, Bristol‐Myers Squibb, Celgene, Dermira, Eli Lilly, Janssen, La Roche‐Posay, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, and Sanofi; personal payment. HL reports grants/grants pending for clinical trials from AbbVie (Abbott), Amgen, AstraZeneca, Bristol‐Myers Squibb, Celgene, Dermira, Eli Lilly, GSK, Incyte, Janssen, La Roche‐Posay, Merck Sharp & Dohme, Moonlake, Novartis, Pfizer, Regeneron, and Sanofi; personal payment. HL reports payment for lectures from AbbVie, Novartis, Sanofi, and Bausch Health; personal payment. HL reports payment for development of educational presentations from AbbVie (Abbott), Celgene, Janssen, Leo Pharmaceutics, Novartis, Sanofi, Pfizer, RAPT, Takeda, UBS, and Pediapharma.

Igor Kaidashev has no conflict of interest to declare in relation to this work.

Iman Nasr has no conflict of interest to declare in relation to this work.

Isabel Ogueta Canales is or recently was a speaker and/or advisor for and/or has received personal fees and grants from L’Oréal, Faes‐Farma and ITF‐Labomed.

Ivan Cherrez‐Ojeda has no conflict of interest to declare in relation to this work.

Jean Bousquet has no conflict of interest to declare in relation to this work.

Jonathan A. Bernstein reports personal fees and grants from Sanofi Regeneron, AZ, Allakos, Celldex, Escient, Novartis, Genentech, Jasper Pharma and being AAAAI immediate past president, WAO BOD, AAAAI Foundation Chairperson, UCARE/ACARE centre, JTF practice parameters committee member.

Jonny Peter declares payments or honoraria for lectures from CSL Behring, Takeda, Novartis and Sanofi Regeneron, participation on a data safety monitoring Board or Adboard for Pharvaris and Astria. Further grants or contracts from Takeda, Kalvista, Astria and Pharvaris.

Jose Ignacio Larco Sousa has no conflict of interest to declare in relation to this work.

Kanokvalai Kulthanan declares payments or honoraria for lectures from Novartis, Menarini, and Sanofi Genzyme.

Karsten Weller declares grants or contracts from Novartis, Sanofi, and Noucor and consulting fees and adboard participation for Novartis.

Kiran Godse has no conflict of interest to declare in relation to this work.

Krzysztof Rutkowski has no conflict of interest to declare in relation to this work.

Lasma Lapina has no conflict of interest to declare in relation to this work.

Laurence Bouillet has consulted/served as speaker for, engaged in research and educational projects with or accepted travel grants from the following companies: BioCryst, CSL Behring, Takeda, Novartis, GSK, Blueprint, Kalvista, Pharvaris.

Luis Felipe Ensina declares consulting fees from Sanofi, honoraria for lectures from Sanofi, Novartis, and Celltrion and travel grants from Sanofi.

Margarida Gonçalo declares consulting fees from AbbVie, Almirall, Biocryst, Boehringer Pfizer, and Novartis and honoraria for lectures from Sanofi, AbbVie, and Pfizer. Further support for travel grants from Sanofi and Almirall.

Maria Staevska has no conflict of interest to declare in relation to this work.

Mariam Ali Yousuf Al‐Nesf has no conflict of interest to declare in relation to this work.

Markus Magerl is an advisor for MOXIE.

Martin Metz has no conflict of interest to declare in relation to this work.

Martijn van Doorn declares grants from Janssen, Almirall, Third Harmonic, and Escient, payments for lectures from Novartis, AbbVie, Leo pharma, Sanofi, Janssen, UCB, and BMS and travel grants from UCB.

Mary Anne Castor has no conflict of interest to declare in relation to this work.

Maryam Khoshkhui has no conflict of interest to declare in relation to this work. Outside of submitted work she was a speaker and/or advisor for and/or has received research funding from Abidi Pharma, Alhavi Pharma, AstraZeneca, Actover, Ofogh Tolid Darou pars, Kimia salamat nikan, CinnaGen, Sanofi, GlaxoSmithKline and Danon.

Michael Makris has no conflict of interest to declare in relation to this work.

Michihiro Hide declares consulting fees from Novartis, Sanofi, Taiho, and Teikoku Seiyaku, and payments or honoraria for lectures from Japan Tobacco, Kaken Pharmaceutical, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma, Meiji Seiyaku, Novartis, Sanofi/Regeneron, and TAIHO Pharmaceutical. Further travel grants from TAIHO Pharmaceutical.

Mohamad Abuzakouk has no conflict of interest to declare in relation to this work.

Mona Al‐Ahmad declares grants or contracts with Kuwait University, payments or honoraria for lectures from AstraZeneca, Novartis, GSK, and Sanofi.

Murat Türk is or recently was a speaker and/or advisor for AstraZeneca, Chiesi, GSK, Novartis, ROXALL, Vem İlaç.

Natasa Teovska Mitrevska has no conflict of interest to declare in relation to this work.

Niall Conlon declares grants or contracts with GSK and Pharming, payments or honoraria for lectures from Novartis and Takeda. Further travel grants from Novartis, Biocryst, and Pharming.

Nicole Nojarov has no conflict of interest to declare in relation to this work.

Pavel Kolkhir declares grants or contracts with Novartis and Sanofi, further consulting fees from BioCryst, Merus, Novartis, and ValenzaBio.

Philip Li has no conflict of interest to declare in relation to this work.

Ramzy Mohammed Ali has no conflict of interest to declare in relation to this work.

Rand Arnaout has no conflict of interest to declare in relation to this work.

Riccardo Asero declares payments of honoraria from GSK, Novartis, Jasper Therapeutics, and Sanofi.

Sabine Altrichter declares grants or contracts with AstraZeneca, and consulting fees from Allakos, ALK, BioCryst, Blueprint, Celltrion, CSL Behring, Galderma, Incyte, KalVista, Leo Pharma, Novartis, Otsuka, Pharvaris, Sanofi, Takeda, and ThermoFisher. Further payments or honoraria for lectures from Allakos, ALK, BioCryst, Blueprint, CSL Behring, Leo Pharma, Novartis, Pharvaris, Sanofi, Takeda, and ThermoFisher. In addition she received travel grants from BioCryst, Takeda, Sanofi, and UCB. Also she was part of Adboards for BioCryst, Takeda, Novartis, AstraZeneca, and Blueprint.

Simon Francis Thomsen Simon Francis Thomsen has received research support from AbbVie, Almirall, Janssen, LEO Pharma, Novartis, Sanofi and UCB, and has been a speaker/consultant for AbbVie, Almirall, Boehringer, CSL, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi, Servier, Symphogen, UCB, and Union Therapeutics.

Young‐Min Ye declares payments or honoraria for lectures from Novartis, Celltrion, and Yuhan.

Zenon Brzoza declares payments or honoraria for lectures from Novartis, Berlin Chemie, Menarini, AstraZeneca, and Sanofi.

Zuotao Zhao is the speaker/advisor for and/or has received research funding from Novartis, Sanofi, Pfizer, Astellas, Galderma, Janssen, GSK, BAYER, LEO, MEDA Pharma and ALK Pharma.

Torsten Zuberbier declares grants or contracts from Novartis and Henkel and consulting fees from Bayer Health Care, Blueprint Medicine, Celldex, Celltrion, FAES, Novartis, and Henkel. Further payments for lectures from AstraZeneca, AbbVie, ALK, Almirall, Astellas, Bayer Healthcare, Bencard, Berlin Chemie, FAES, HAL, Leti, Meda, Menarini, Merck, MSD, Novartis, Pfizer, Sanofi, Stallergenes, Takeda, Teva, UCB, Henkel, Kryolan, and L’Oréal. He was part of adboards for Novartis, Celldex, and AbiVax.

Frank Siebenhaar declares grants or contracts with Alys/Granular Pharma, Blueprint Medicine, Cogent Biosciences, Celldex, and Telios Pharma, consulting fees from Blueprint Medicine, and Cogent Biosciences, payments or honoraria for lectures from Blueprint Medicine, Cogent Biosciences, and Novartis. He was part of adboards for Blueprint and Cogent.

Emek Kocatürk was recently a speaker/consultant for Menarini and Novartis and received funding from Almirall.

Sophia Neisinger has been an advisor/speaker for or received research funding from Novartis, Celltrion and/or Sanofi.

Figures

FIGURE 1
FIGURE 1
Directed acyclic graph (DAG) to select the independent variables to include in multivariable models.

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