Disparities in chronic spontaneous urticaria: Eligibility for drug reimbursement associated with clinical outcomes
Background: Chronic spontaneous urticaria (CSU) is an immunologic condition with an estimated prevalence of 0.1%. For CSU that is poorly controlled despite the use of antihistamines, omalizumab is the only treatment approved and recommended by international guidelines. Objective: Our aim was to outl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-05-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829324000390 |
| _version_ | 1797235482199851008 |
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| author | Hugo W.F. Mak, MBBS MRes(Med) Valerie Chiang, MBBS Elsie T.S. Chan, BNurs Elaine Lee, MSc Jackie S.H. Yim, MSc Dorothy L.Y. Lam, MSc Philip H. Li, MD, FRCP |
| author_facet | Hugo W.F. Mak, MBBS MRes(Med) Valerie Chiang, MBBS Elsie T.S. Chan, BNurs Elaine Lee, MSc Jackie S.H. Yim, MSc Dorothy L.Y. Lam, MSc Philip H. Li, MD, FRCP |
| author_sort | Hugo W.F. Mak, MBBS MRes(Med) |
| collection | DOAJ |
| description | Background: Chronic spontaneous urticaria (CSU) is an immunologic condition with an estimated prevalence of 0.1%. For CSU that is poorly controlled despite the use of antihistamines, omalizumab is the only treatment approved and recommended by international guidelines. Objective: Our aim was to outline the impact of treatment accessibility on CSU outcomes in the real world. Methods: Serial data on adult patients with CSU receiving care for at least 6 months at a dedicated, immunologist-led urticaria clinic at Grantham Hospital in Hong Kong between 2018 and 2023 were analyzed. Patients’ clinicodemographic data, drug eligibility status (eligible for reimbursement or not), treatment step, and disease activity (weekly Urticaria Activity Score [UAS7]) were collected and compared according to drug eligibility status. Results: This study included 238 patients, 80 (33.6%) of whom were eligible for reimbursement and 158 of whom were not. No significant clinicodemographic differences, including disease activity, were found at baseline. At latest follow-up, significantly more patients in the eligible group were receiving omalizumab (28.7% vs 5.7% [P < .001]), which is equivalent to a multivariate odds ratio of 9.35 (95% CI = 3.689-23.703 [P < .001]). The discrepancy persisted even in patients with moderate-to-severe CSU whose UAS7 was 16 or higher (40.6% [13 of 32] vs 10.2% [6 of 59]; P < .001). In addition, there was significantly less dose reduction (<300 mg every 4 weeks) in the eligible omalizumab users (4.3% vs 44.4% [P = .015]). Clinically, significantly greater improvements in UAS7 were reported by the eligible group (median change –8.0 vs –5.0 [P = .021]). Conclusion: Patterns of management varied largely among patients with different drug eligibility statuses and led to disparities in health outcomes. More efforts to secure equitable access to guideline-based CSU care are warranted. |
| first_indexed | 2024-04-24T16:48:39Z |
| format | Article |
| id | doaj.art-a39a38c2f3314f6f8d05511a8502ec77 |
| institution | Directory Open Access Journal |
| issn | 2772-8293 |
| language | English |
| last_indexed | 2024-04-24T16:48:39Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Allergy and Clinical Immunology: Global |
| spelling | doaj.art-a39a38c2f3314f6f8d05511a8502ec772024-03-29T05:51:27ZengElsevierJournal of Allergy and Clinical Immunology: Global2772-82932024-05-0132100243Disparities in chronic spontaneous urticaria: Eligibility for drug reimbursement associated with clinical outcomesHugo W.F. Mak, MBBS MRes(Med)0Valerie Chiang, MBBS1Elsie T.S. Chan, BNurs2Elaine Lee, MSc3Jackie S.H. Yim, MSc4Dorothy L.Y. Lam, MSc5Philip H. Li, MD, FRCP6Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongDivision of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong KongDivision of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongDivision of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongDivision of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongDivision of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongDivision of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; Corresponding author: Philip H. Li, MD, FRCP, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong.Background: Chronic spontaneous urticaria (CSU) is an immunologic condition with an estimated prevalence of 0.1%. For CSU that is poorly controlled despite the use of antihistamines, omalizumab is the only treatment approved and recommended by international guidelines. Objective: Our aim was to outline the impact of treatment accessibility on CSU outcomes in the real world. Methods: Serial data on adult patients with CSU receiving care for at least 6 months at a dedicated, immunologist-led urticaria clinic at Grantham Hospital in Hong Kong between 2018 and 2023 were analyzed. Patients’ clinicodemographic data, drug eligibility status (eligible for reimbursement or not), treatment step, and disease activity (weekly Urticaria Activity Score [UAS7]) were collected and compared according to drug eligibility status. Results: This study included 238 patients, 80 (33.6%) of whom were eligible for reimbursement and 158 of whom were not. No significant clinicodemographic differences, including disease activity, were found at baseline. At latest follow-up, significantly more patients in the eligible group were receiving omalizumab (28.7% vs 5.7% [P < .001]), which is equivalent to a multivariate odds ratio of 9.35 (95% CI = 3.689-23.703 [P < .001]). The discrepancy persisted even in patients with moderate-to-severe CSU whose UAS7 was 16 or higher (40.6% [13 of 32] vs 10.2% [6 of 59]; P < .001). In addition, there was significantly less dose reduction (<300 mg every 4 weeks) in the eligible omalizumab users (4.3% vs 44.4% [P = .015]). Clinically, significantly greater improvements in UAS7 were reported by the eligible group (median change –8.0 vs –5.0 [P = .021]). Conclusion: Patterns of management varied largely among patients with different drug eligibility statuses and led to disparities in health outcomes. More efforts to secure equitable access to guideline-based CSU care are warranted.http://www.sciencedirect.com/science/article/pii/S2772829324000390Urticariachronic urticariaCSUhealth disparitiesequitybiologics |
| spellingShingle | Hugo W.F. Mak, MBBS MRes(Med) Valerie Chiang, MBBS Elsie T.S. Chan, BNurs Elaine Lee, MSc Jackie S.H. Yim, MSc Dorothy L.Y. Lam, MSc Philip H. Li, MD, FRCP Disparities in chronic spontaneous urticaria: Eligibility for drug reimbursement associated with clinical outcomes Journal of Allergy and Clinical Immunology: Global Urticaria chronic urticaria CSU health disparities equity biologics |
| title | Disparities in chronic spontaneous urticaria: Eligibility for drug reimbursement associated with clinical outcomes |
| title_full | Disparities in chronic spontaneous urticaria: Eligibility for drug reimbursement associated with clinical outcomes |
| title_fullStr | Disparities in chronic spontaneous urticaria: Eligibility for drug reimbursement associated with clinical outcomes |
| title_full_unstemmed | Disparities in chronic spontaneous urticaria: Eligibility for drug reimbursement associated with clinical outcomes |
| title_short | Disparities in chronic spontaneous urticaria: Eligibility for drug reimbursement associated with clinical outcomes |
| title_sort | disparities in chronic spontaneous urticaria eligibility for drug reimbursement associated with clinical outcomes |
| topic | Urticaria chronic urticaria CSU health disparities equity biologics |
| url | http://www.sciencedirect.com/science/article/pii/S2772829324000390 |
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