EFFECTIVENESS OF OUTPATIENT PHARMACOTHERAPY FOR PATIENTS WITH CHRONIC SPONTANEOUS URTICARIA

Introduction. Outpatient pharmacotherapy for patients with chronic spontaneous urticaria fails to control symptoms in a significant number of patients. Clinical guidelines recommend a stepwise approach to drug therapy for these patients. However, in real-world clinical practice, drug selection is often empirical, rather than in accordance with clinical guidelines for the disease. AIM of study: to conduct a retrospective analysis of outpatient pharmacotherapy in patients with chronic spontaneous urticaria in order to improve its effectiveness. Materials and methods. An analysis of the medical records of 295 adult patients with chronic spontaneous urticaria, primarily hospitalized in the Smolensk Regional Center for Allergology and Immunology in the period from 2014 to 2024, was conducted. The mean age of patients at the time of hospitalization was 44.1±0.86 years (range, 18–83 years), the mean age of disease onset was 42.1±0.99 years (range, 3–83 years), and the mean duration of CSU at the time of first hospitalization was 28.3±3.13 months (range, 2–470 months). There were 228 women (77.3%; 95% CI: 72.5–82.1%) and 67 men (22.7%; 95% CI: 17.9–27.5%) among the patients. RESULTS. At the outpatient stage, 256 patients out of 295 (86.8%; 95% CI: 82.9-90.6%) took second-generation antihistamines in doses prescribed in clinical guidelines. The remaining 39 patients (13.2%; 95% CI: 9.4-17.1%) used drugs outside clinical guidelines (first-generation antihistamines, a long course of systemic glucocorticoids, mast cell membrane stabilizers, a more than 4-fold increased dose of second-generation antihistamines). Despite the conducted pharmacotherapy (both according to clinical guidelines and outside them), only 116 patients (39.3%; 95% CI: 33.7-44.9%) noted positive control over disease symptoms at the outpatient stage of treatment. In 179 patients (60.7%; 95% CI: 55.1-66.3%), no improvement in disease symptoms was observed. No significant difference in urticaria symptom control was found depending on the dose of second-generation antihistamines. Second (omalizumab) and third (cyclosporine A) line medications were not used during outpatient treatment. CONCLUSIONS. The obtained data indicate the need to optimize pharmacotherapy of patients with chronic spontaneous urticaria at the outpatient stage in order to increase its effectiveness.