BACKGROUND: Chronic urticaria (CU) is characterised by repeated occurrence of itchy and sometimes painful hives and/or angioedema for 6 weeks or longer. Treatment guidelines are available (EAACI/GA2LEN/EDF/WAO), but data are lacking on the actual therapies prescribed to European CU patients.
METHODS: Current treatment data from CU patients residing in Europe (EU) collected at enrolment in the ongoing observational AWARE study are presented alongside quality of life (QOL) measured by the Dermatology Life Quality Index (DLQI). Patients were aged 18 years or older and refractory to at least one course of H1-antihistamines (H1-AH). Data were split into regions for comparison: United Kingdom (UK), Nordic countries (Sweden, Norway, Denmark), Southern Europe (SE: Belgium, France, Portugal, Spain, Italy, Greece), Germany, and Russia.
RESULTS: At enrolment, 3,733 patients provided data (UK, n=261; Nordic, n=160; SE, n=922; Germany, n=2,247; Russia, n=141), and 58% were receiving treatment. Among those, 57% were treated with a second-generation H1-AH; escalation to recommended third-line therapy was observed in 32% (26.2% omalizumab, 0.9% ciclosporin, 4.5% montelukast, 0.8% combination). Nordic patients were most likely to be receiving treatment (74%) followed by Germany (61%), SE (58%), UK (52%), and Russia (39%). Among Nordic patients receiving treatment, second-generation H1-AHs were taken by 38%, while 59% had already escalated to a third-line therapy. Corresponding numbers were as follows: Germany, 63% and 27%; SE, 47% and 40%; UK, 43% and 40%; and Russia, 66% and 22%. Combination treatment with corticosteroids alongside third-line therapy was rare (2%), as was treatment with other non-guideline medications (6%). UK patients were much more likely to receive non-guideline recommended treatment (21%) compared with Nordic (3%), German (4%), SE (8%), or Russian (13%) patients. The effect of urticaria on QOL was reported as moderate, very large, or extremely large in 54% of Nordic patients, 51% of SE patients, 56% of German patients, 61% of UK patients, and 85% of Russian patients.
CONCLUSION: A substantial proportion of European CU patients are currently not prescribed any CU treatment, despite being under medical care. Many CU patients appear to be refractory to H1-AH and show a substantial burden in QOL. Moreover, only a third of enrolled patients had been escalated to recommended third-line therapies.
