The Urticaria Voices Study: Physicians' Perspectives on the Real-World Patient Burden, Treatments, and Outcomes in Chronic Spontaneous Urticaria.

Introduction: Chronic spontaneous urticaria (CSU) significantly impacts patients' quality of life (QOL). Understanding physicians' perspectives and treatment approaches for CSU is crucial for optimizing the outcomes. We describe the CSU management challenges and treatment perceptions reported by physicians in the Urticaria Voices study.

Methods: This is a multinational cross-sectional online survey involving patients with CSU and CSU-treating physicians from seven countries (USA, Canada, UK, Germany, France, Italy, and Japan). The reported analyses assessed prescribing patterns, treatment satisfaction, and disease management challenges for physicians. Data were analyzed descriptively.

Results: Overall, 862 physicians (517 dermatologists; 345 allergists) participated in the study. Fifty-two percent perceived CSU as serious and 65% reported that CSU negatively impacts patients' life, particularly mental well-being (mean [SD], 8.2 [1.7]; 10-point scale). Key challenges included treatment-related issues (approx. 66%) and diagnosis (39%). Globally, 56% of physicians adhered to guidelines, 19% followed therapeutic protocols, and approximately 30% did not adhere to any guideline. Physicians reported that 80% of patients were on H₁-antihistamines (H1-AH; second-generation H1-AH [sgH1-AH], 57%; first-generation H1-AH, 23%), 29% on steroids, and 21% on omalizumab. Overall, 67% of physicians were satisfied with omalizumab and 33% with sgH1-AH. For patients inadequately controlled on H1-AH, physicians doubled (21%) or quadrupled (32%) H1-AH dose or added omalizumab (11%) or another sgH1-AH (10%). Key treatment goals were improving patients' QOL (81%) and being free of itch and hives (75%); approximately, half of the physicians (51%) reported success in achieving complete symptom control. Unmet needs included better understanding of CSU etiology (48%), better access to treatments (47%), and reduced administrative barriers for prescribing biologics (45%).

Conclusion: Improving patients' QOL and diagnosis- and treatment-related challenges is critical in CSU management from physicians' perspective. Despite higher satisfaction with omalizumab, predominant use of sgH1-AH and reluctance to escalate to omalizumab indicate areas for improving treatment strategies in CSU care. Notably, reluctance to escalate to biologics may be partly due to limited availability and barriers to access in certain countries, which must be addressed to optimize care globally.