Unmet Needs in Treatment Escalation for Chronic Spontaneous Urticaria: Findings From the CURE Registry
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
Source: Allergy
DOI: 10.1111/all.70199
Authors: Pavel Kolkhir, Pascale Salameh, Magdalena Zajac, Alicja Kasperska‐Zajac, Ana Giménez‐Arnau, Maria Puertolas, Hanna Bonnekoh, Carolina Vera Ayala, Michael Makris, Eleni Chatzidimitriou, Stamatios Gregoriou, Kanokvalai Kulthanan, Andrea Bauer, Mojca Bizjak‐Suran, Daria Fomina, Alexis Bocquet, Joachim Dissemond, Mohamed Abuzakouk, Tara Raftery, Nadine Chapman‐Rothe, Emek Kocatürk, Clive Grattan, Riccardo Asero, Jonny G. Peter, Simon Francis Thomsen, Karsten Weller
Institutions: Humboldt-Universität zu Berlin, Fraunhofer Institute for Translational Medicine and Pharmacology, Charité - Universitätsmedizin Berlin, University of Nicosia, Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Lebanese American University, Medical University of Silesia, Universitat Pompeu Fabra, Hospital del Mar Research Institute, National and Kapodistrian University of Athens, University General Hospital Attikon, Andreas Sygros Hospital, Siriraj Hospital, Mahidol University, University Hospital Carl Gustav Carus, Technische Universität Dresden, University of Ljubljana, University of Maribor, University Clinic of Pulmonary and Allergic Diseases Golnik, Sechenov University, Astana Medical University, Moscow Clinical Science and Research Center 52, Centre Hospitalier Universitaire de Grenoble, Essen University Hospital, University of Duisburg-Essen, Cleveland Clinic Abu Dhabi, Novartis (Ireland), Novartis (Switzerland), Bahçeşehir University, Guy's Hospital, University of Cape Town, Groote Schuur Hospital, University of Copenhagen, Bispebjerg Hospital
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,300
Funders: Cleveland Clinic, Lebanese American University, Universitat Pompeu Fabra, Université Libanaise, Mahidol University, National and Kapodistrian University of Athens, Humboldt-Universität zu Berlin, University of Cape Town, Freie Universität Berlin, Univerza v Ljubljani, Univerza v Mariboru, Śląski Uniwersytet Medyczny w Katowicach, I.M. Sechenov First Moscow State Medical University, Uniwersytet Śląski w Katowicach, Bahçeşehir Üniversitesi, Bispebjerg Hospital, University of Nicosia, Novartis Pharma, Faculty of Medicine Siriraj Hospital, Mahidol University
OpenAlex ID: W7124141305