The Benefit of Complete Response to Treatment in Patients With Chronic Spontaneous Urticaria—CURE Results

Abstract

Chronic spontaneous urticaria (CSU) is a distressing disease. We report real-world data from the global Chronic Urticaria Registry (CURE) about associations between various CSU states and sleep impairment, plus important health-related quality-of-life (HRQoL) outcomes and compared different methods to assess CSU states. CURE data were collected at baseline and 6-monthly follow-ups (FU). Assessments included CSU states using the Urticaria Control Test (UCT), weekly Urticaria Activity Score (UAS7), and Physician Global Assessment (PhyGA) of treatment response. Complete response to treatment (CR, UAS7= 0), complete control of disease (CC, UCT= 16), and PhyGA= CR were assessed, plus the Dermatology Life Quality Index and the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL) sleep domain. Overall, 2078 patients were included. At baseline, 9.8%, 17.9%, and 42.3% of patients had UCT= 16, UAS7= 0, or PhyGA= CR, respectively, which increased at FU1 and FU2. Patients with higher UCT scores had better sleep and HRQoL. The presence of angioedema without wheals, episodic disease, omalizumab treatment, and male sex were associated with CC (P < .05). Among 469 patients who achieved CC or CR, 16.4% (n= 77) showed CC or CR with all 3 instruments. Agreement between UCT= 16 and UAS7= 0 measurements was moderate (κ= 0.581), but poor between UCT= 16 and PhyGA= CR (κ= 0.208). Few patients had CR/CC of their CSU at baseline entry. Disease control strongly related to good sleep and better HRQoL; therefore, it is important to aim for CR in CSU treatment. Patient-reported UCT and UAS7 assessments demonstrated a more accurate measurement of CSU state versus physician assessments.