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Title: Clinical characteristics and management of chronic spontaneous urticaria in patients refractory to H<inf>1</inf>-Antihistamines in Asia, Middle-East and Africa: Results from the AWARE-AMAC study
Authors: Chia Yu Chu
Anwar Al Hammadi
Nancy Agmon-Levin
Nilgun Atakan
Assem Farag
Rand K. Arnaout
Suretha Kannenberg
Kanokvalai Kulthanan
Asmara Mubarak
Fares Zaitoun
Susanne Crowe
Sigrid Malfait
Kathryn Cooke
Elise L. Dekker
Dubai Health Authority
Benha University
National Taiwan University College of Medicine
Hacettepe Üniversitesi
King Faisal Specialist Hospital and Research Centre
Chaim Sheba Medical Center Israel
Faculty of Medicine, Siriraj Hospital, Mahidol University
Novartis International AG
Stellenbosch University
Novartis Ireland Limited
Armed Forces Hospital
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Apr-2020
Citation: World Allergy Organization Journal. Vol.13, No.4 (2020)
Abstract: © 2020 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).
ISSN: 19394551
Appears in Collections:Scopus 2020

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