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Chu CY, Al Hammadi A, Agmon-Levin N, Atakan N, Farag A, Arnaout RK, Kannenberg S, Kulthanan K, Mubarak A, Zaitoun F, Crowe S, Malfait S, Cooke K, Dekker EL. Clinical characteristics and management of chronic spontaneous urticaria in patients refractory to H 1-Antihistamines in Asia, Middle-East and Africa: Results from the AWARE-AMAC study. World Allergy Organ J 2020; 13:100117. [PMID: 32382379 PMCID: PMC7200453 DOI: 10.1016/j.waojou.2020.100117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/21/2020] [Accepted: 03/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Chronic urticaria (CU) is a condition characterized by recurrent itchy hives and/or angioedema for ≥6 weeks. Most of the data about CU come from western countries with very little information available about CU in Asia, Africa, and the Middle East. Methods AWARE-AMAC is a 24-month prospective, observational, real-world, non-interventional study in patients aged ≥18 years from Asia, the Middle East, and Africa (AMAC) with CU refractory to H1-antihistamines (H1-AH). The main objective was to describe the real-world experience with CU, including clinical characteristics, presence of angioedema, treatment patterns (shifts between treatment classes and changes within a treatment class), investigator-assessed disease control, and the impact on quality of life. Subgroups of interest were type of CU at Baseline and treatment class (based on 2013 urticaria guidelines). There were no mandatory visits and diagnostic/monitoring procedures additional to routine practice, except the patient diary (7-day Urticaria Activity Score) and patient reported outcome assessments. Results The focus of the current manuscript is on patients with chronic spontaneous urticaria (CSU), who formed 98% of the sample. Patients were predominantly female (69.6% female, mean age ± SD 39.8 ± 13.29 years). Time since current diagnosis (Mean ± SD) was 28.6 ± 49.06 months. Amongst patients with CSU, 31.0% had comorbid chronic inducible urticaria (CINDU) and 46.4% had a history of angioedema. 91.9% received H1-AH therapy (±other treatments). The most frequently prescribed treatment classes at Baseline were any/combination of medications, not classified under the other 7 treatment classes, named “Others” (30.5%) followed by, omalizumab (OMA; 23.6%) and second-generation H1-AH monotherapy (sgAH; 15.1%). At Month 12, the most prescribed treatment classes (>15%) for patients were OMA (23.5%) and "Other" (21.3%); 19.7% received "No drug". At Month 24, OMA (22.5%), and "Other" (17.9%) were most frequently prescribed; 28.6% received "No drug". Overall, 79.5% of patients had some type of change in treatment. Over the study period, improvement in self-reported QoL increased, which was mirrored by better disease control. Conclusion In AMAC countries, the non-recommended "Other" treatment class played a major role in the initial management of CU patients. High usage of H1-AH (±other treatments) and OMA was observed. Treatment changes were observed in a majority of patients. Treatment escalation from sgAH was mostly via OMA. Improvement of disease control and QoL was achieved during the study period. Trial registration Observational study (NA).
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Key Words
- AMAC, Asia Middle East and Africa
- CINDU, Chronic inducible urticarial
- CSU, Chronic spontaneous urticarial
- CU, Chronic urticaria
- Chronic spontaneous urticaria
- CsA, Cyclosporine A
- DLQI, Dermatology Life Quality Index
- Efficacy
- GCP, Good Clinical Practice
- H1-AH, H1-antihistamines
- HRCU, H1-antihistamines refractory chronic urticarial
- HRQoL, Health-related quality of life
- MONT, Montelukast monotherapy, or in combination with any H1-AH
- OMA, Omalizumab monotherapy, or in combination with any H1-AH, with or without steroids
- Omalizumab
- PRO, Patient-reported outcomes
- PhyGA-VAS, Physician Global Assessment of disease control-visual analog scale
- QoL, Quality of life
- Quality of life
- SD, Standard deviation
- SGC, Systemic glucocorticosteroids monotherapy, or in combination with any H1-AH
- Second-generation antihistamines
- UAS7, 7-day Urticaria Activity Score
- fgAH, First-generation antihistamines monotherapy, or in combination with sgAH
- sgAH, Second-generation antihistamines monotherapy approved dose: once daily or as needed
- sgAHUP, Updosed second-generation H1-AH
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Affiliation(s)
- Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Anwar Al Hammadi
- Dermatology Center, Dubai Health Authority, Dubai, United Arab Emirates
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Department, z Center for Autoimmune Diseases, Sheba Medical Centre, Ramat Gan, Israel
| | - Nilgun Atakan
- Department of Dermatology, Hacettepe University, Ankara, Turkey
| | - Assem Farag
- Dermatology Department, Faculty of Medicine, Benha University, Cairo, Egypt
| | - Rand K Arnaout
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Suretha Kannenberg
- Division of Dermatology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Fares Zaitoun
- Allergy, Asthma & Immunology Center Specialty Clinics Center, Beirut, Lebanon
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