Unmet Needs in Treatment Escalation for Chronic Spontaneous Urticaria: Findings From the CURE Registry

ABSTRACT Background Many patients with chronic spontaneous urticaria (CSU) remain symptomatic despite receiving second‐generation H 1 ‐antihistamines (sgH 1 ‐AH). This data analysis from the Chronic Urticaria Registry (CURE) aimed to describe treatment patterns and identify unmet needs in real‐world practice. Methods CURE is an international, prospective registry of patients with chronic urticaria. Treatment responses were categorized as Urticaria Control Test (UCT) changes from baseline (BL) to 6‐month follow‐up (FU). Complete response was defined as UCT = 16 with a ≥ 3‐point increase. Results Data were available from 3995 adult patients with CSU at BL and 1288 at FU with evaluable UCT. After treatment escalation from BL to FU, 5.3% (no treatment to licensed‐dose sgH 1 ‐AH), 6.0% (licensed‐dose sgH 1 ‐AH to up‐dosed sgH 1 ‐AH), and 28.4% (any dose sgH 1 ‐AH to omalizumab) achieved complete response. Factors associated with a lower probability of treatment escalation at FU were UCT ≥ 12 and omalizumab treatment at BL (both p < 0.0001). About one‐third (28.6%) of patients clinically eligible for escalation at BL (UCT < 12) did not receive step‐up treatment (18.0%) or were even stepped down (10.6%) and remained poorly controlled at FU. Factors associated with lack of escalation in this group included younger age ( p = 0.014), shorter disease duration ( p = 0.071), presence of wheals and angioedema ( p = 0.002), better quality of life ( p = 0.001), and treatment with up‐dosed sgH 1 ‐AH ( p = 0.031). Conclusion Appropriate treatment escalation improves CSU control, although only about a quarter of patients achieve a complete response, indicating the need for novel treatments. Many patients with poorly controlled CSU do not receive guideline‐recommended treatment escalation and remain symptomatic on their current treatments, which deserves further attention.