Chronic Spontaneous Urticaria Management and the Role of Patient Communication

EP: 1.Overview and Burden of Chronic Spontaneous Urticaria

EP: 2.Diagnosis, Severity, and Impact of Chronic Spontaneous Urticaria

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EP: 3.Chronic Spontaneous Urticaria Management and the Role of Patient Communication

EP: 4.Chronic Spontaneous Urticaria: Diagnosis and Treatment Strategies

Jane Mast, PhD, DMSc, MPAS, PA-C: Hello and welcome back to this Dermatology Times Partner Perspectives video series on chronic spontaneous urticaria, or CSU.

My name is Jane Mast. I'm a Novartis Medical Director of Dermatology and Allergy, and joining me today is Dr Jonathan Rodrigues, also a Novartis Medical Director of Dermatology and Allergy, and a board- certified allergist. Thanks so much for being here with us today.

Jonathan Rodrigues, MD: Thank you, Jane.

Jane Mast, PhD, DMSc, MPAS, PA-C: For this last video, we're going to look at the management strategies and also talk about how communication with patients can shape management approaches.
What are the current treatment options for CSU, and what are the most notable challenges?

Jonathan Rodrigues, MD: According to the international treatment guidelines, second- generation H1 antihistamines are the recommended first-line therapy in patients with CSU, and patients could be updosed to fourfold the standard dosing per guideline recommendations.¹ Approximately 50% to 60% of patients do not respond to standard doses of second- generation antihistamines.^2,3 About 38% to 54% of patients may still not respond to even fourfold standard doses of antihistamines.³ Patients who do not respond to antihistamine therapy often report significantly decreased quality of life.⁴ If the disease remains poorly controlled after treatment escalation, even up to fourfold, the standard dose of second- generation antihistamines, the treatment regimen could be modified.¹ There are several management challenges in patients with CSU. A short course of systemic steroids could be used in rescue cases of acute exacerbations of CSU, but it is not recommended to use these as long-term therapy because of their adverse effects.¹ Late diagnosis can impact comorbid or mask certain diseases,^5,6 and the paucity of reliable biomarkers to assess disease severity and predict treatment response can be another challenge in managing patients with CSU.⁵

Jane Mast, PhD, DMSc, MPAS, PA-C: Given the impact of CSU on patient quality of life, what is the importance of patient communication and shared decision-making in the management of patients with CSU?

Jonathan Rodrigues, MD: Through a review of symptoms, comorbidities, disease severity, patient preferences, potential side effects of treatment, and disease monitoring with UAS7, health care providers can help guide treatment decisions, escalations, and modifications.^1,7,8 The treatment of CSU aims to alleviate the physical, psychological, and work productivity impairments that this disease can have in the lives of patients.⁷

Jane Mast, PhD, DMSc, MPAS, PA-C: Thank you so much, Jonathan, for this informative discussion on CSU, and thank you again to all our viewers for watching.

References
1. Zuberbier T et al. Allergy. 2022;77(3):734-766
2. Shah B, et al. Clin Cosmet Inves1g Dermatol. 2022;15:261-270.
3. Danilycheva I, et al. Postepy Dermatol Alergol. 2022;39(3):509-516.
4. Hoskin B et al. Curr Med Res. 2019;35(8):1387-1395.
5. Sanchez-Borges M et al. World Allergy Organ J. 2021;14(6):100533.
6. Maurer M et al. Allergy. 2017;72(12):2005-2016.
7. Vietri J et al. Ann Allergy Asthma Immunol. 2015;115(4):306-311.
8. Kaplan AP. Allergy Asthma Immunol Res. 2017;9(6):477-482.