Unmet Needs in Treatment Escalation for Chronic Spontaneous Urticaria: Findings From the CURE Registry
Kolkhir P. Salameh P. Zajac M. Kasperska-Zajac A. Giménez-Arnau A. Puertolas M. Bonnekoh H. Vera Ayala C. Makris M. Chatzidimitriou E. Gregoriou S. Kulthanan K. Bauer A. Bizjak-Suran M. Fomina D. Bocquet A. Dissemond J. Abuzakouk M. Raftery T. Chapman-Rothe N. Kocatürk E. Grattan C. Asero R. Peter J.G. Thomsen S.F. Weller K.
2026John Wiley and Sons Inc
Allergy: European Journal of Allergy and Clinical Immunology
2026
Background: Many patients with chronic spontaneous urticaria (CSU) remain symptomatic despite receiving second-generation H1-antihistamines (sgH1-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 sgH1-AH), 6.0% (licensed-dose sgH1-AH to up-dosed sgH1-AH), and 28.4% (any dose sgH1-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 sgH1-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.
antihistamine , chronic spontaneous urticaria , chronic urticaria registry (CURE) , real-world practice , treatment escalation
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Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
School of Medicine, Lebanese American University, Byblos, Lebanon
Institut National de Santé Publique Dépidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
European Center for Diagnosis and Treatment of Urticaria, Medical University of Silesia, Katowice, Poland
Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
Allergy Unit “D. Kalogeromitros”, 2nd Department, Dermatology and Venereology, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
National and Kapodistrian University of Athens, 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Faculty of Maribor, University of Maribor, Maribor, Slovenia
Moscow City Research and Practical Center of Allergy and Immunology, State Budgetary Healthcare Institution “Moscow Clinical Science and Research Hospital 52 of Moscow Healthcare Department”, Moscow, Russian Federation
Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russian Federation
Department of Pulmonology, Astana Medical University, Astana, Kazakhstan
Department of Internal Medicine and Clinical Immunology, CHU Grenobles Alpes, Grenoble, France
Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
Allergy & Immunology Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
Novartis Ireland Ltd., Dublin, Ireland
Novartis Pharma AG, Basel, Switzerland
Bahçeşehir University School of Medicine, Department of Dermatology, Istanbul, Turkey
Guys Hospital, St Johns Institute of Dermatology, London, United Kingdom
Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy
Allergy and Immunology Unit, UCT Lung Institute, Cape Town, South Africa
Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town (UCT), Cape Town, South Africa
Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
Institute of Allergology
Fraunhofer Institute for Translational Medicine and Pharmacology ITMP
School of Medicine
Institut National de Santé Publique Dépidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB)
Department of Primary Care and Population Health
Faculty of Pharmacy
European Center for Diagnosis and Treatment of Urticaria
Department of Dermatology
Allergy Unit “D. Kalogeromitros”
National and Kapodistrian University of Athens
Department of Dermatology
Department of Dermatology
Division of Allergy
Faculty of Medicine
Faculty of Maribor
Moscow City Research and Practical Center of Allergy and Immunology
Department of Clinical Immunology and Allergy
Department of Pulmonology
Department of Internal Medicine and Clinical Immunology
Department of Dermatology
Allergy & Immunology Department
Novartis Ireland Ltd.
Novartis Pharma AG
Bahçeşehir University School of Medicine
Guys Hospital
Ambulatorio di Allergologia
Allergy and Immunology Unit
Division of Allergy and Clinical Immunology
Department of Dermatology
Department of Biomedical Sciences
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