Türk Murat, Kocatürk Emek, Ertaş Ragıp, Ensina Luis Felipe, Mariel Ferrucci Silvia, Grattan Clive, Vestergaard Christian, Zuberbier Torsten, Maurer Marcus, Giménez-Arnau Ana Maria
Department of Chest Diseases, Division of Allergy and Clinical Immunology, Erciyes University School of Medicine, Kayseri, Turkey.
Clinic of Allergy and Clinical Immunology, Kayseri City Education and Research Hospital, Kayseri, Turkey.
Clin Transl Allergy. 2024 Feb;14(2):e12343. doi: 10.1002/clt2.12343.
Although there have been significant advances in the treatment of chronic spontaneous urticaria (CSU) in recent years, there remains a lack of clear guidance on when and how to step down treatment in responders. This study aims to investigate stepping down approaches of different steps of CSU treatment from a global perspective.
"Stepping down chronic spontaneous urticaria treatment" (SDown-CSU) is an international, multicenter, observational, cross-sectional, survey-based study of the Urticaria Centers of Reference and Excellence (UCARE) network. The questionnaire included 48 questions completed by physicians in the UCARE network.
Surveys completed by 103 physicians from 81 UCAREs and 34 countries were analyzed. Seventy-eight percent of the participants responded that they had a national urticaria management guideline written by their professional societies and 28% responded that they had to operate under a regulatory guideline proposed by central health funding organizations. Seventy-two and 58.7% of these national recommendations do not contain any detailed information on when and/or how CSU treatment should be discontinued. There was a lack of detailed information on antihistamines and cyclosporine in particular. A predefined maximum duration was generally not applicable to omalizumab and cyclosporine (81% and 82%, respectively). Nearly all UCAREs step down omalizumab within 6 months from the first controlled status and 42% discontinue cyclosporine after 6 months regardless of the control status.
The findings from the SDown-CSU study clearly highlight a global need for guidance on the process of stepping down treatment in CSU. Additionally, the study offers a step-down algorithm applicable to all stages of CSU treatment.
尽管近年来慢性自发性荨麻疹（CSU）的治疗取得了显著进展，但对于缓解期患者何时以及如何逐步减少治疗，仍缺乏明确的指导。本研究旨在从全球视角探讨CSU治疗不同阶段的逐步减量方法。
“慢性自发性荨麻疹治疗的逐步减量”（SDown-CSU）是一项由荨麻疹参考与卓越中心（UCARE）网络开展的国际性、多中心、观察性、横断面、基于调查的研究。问卷包含48个问题，由UCARE网络中的医生填写。
分析了来自81个UCARE、34个国家的103名医生完成的调查。78%的参与者表示他们有专业协会编写的国家荨麻疹管理指南，28%的参与者表示他们必须按照中央卫生资助组织提出的监管指南进行操作。这些国家建议中，分别有72%和58.7%没有包含关于何时和/或如何停止CSU治疗的任何详细信息。特别是关于抗组胺药和环孢素缺乏详细信息。预定义的最长疗程通常不适用于奥马珠单抗和环孢素（分别为81%和82%）。几乎所有UCARE在首次病情得到控制后的6个月内逐步减少奥马珠单抗的使用，42%的UCARE在6个月后停用环孢素，无论病情是否得到控制。
SDown-CSU研究的结果清楚地表明全球需要关于CSU治疗逐步减量过程的指导。此外，该研究提供了一种适用于CSU治疗所有阶段的逐步减量算法。
