Leveraging Real-World Evidence to Assess Differences in Management of Chronic Spontaneous Urticaria

Innovative treatments may offer pathways to improve the management of chronic spontaneous urticaria (CSU), but gaps in access to those therapies and variations in disease management and prescribing patterns persist.

While antihistamines are the recommended first-line treatment for patients with CSU, the emergence of advanced therapies, including biologics, offers promise to those whose disease remains uncontrolled following antihistamine use. Although systemic corticosteroid use could be helpful to such patients in the short term, clinical guidelines recommend limiting their long-term use due to the risk of serious side effects.

However, real-world evidence reveals meaningful differences in treatment patterns and health care utilization among patients with CSU, including variation in access to advanced therapies and reliance on systemic corticosteroids and emergency services.

 

To assess disparities in treatment, health care resource use (HCRU), and adverse events among patients with CSU, we examined a large US insurance claims database. Our study was descriptive in nature and no formal comparisons were performed. Below, we summarize some of our key findings.

Treatment Differences by Race and Insurance Coverage

Descriptively on average, we identified notable differences in disease management across racial and insurance subgroups of patients. For instance, Black patients with Medicaid had the highest rates of systemic corticosteroid use and emergency room visits among the populations studied. Despite these indicators of greater acute care utilization, this group also experienced among the lowest rates of biologic initiation, as compared to other groups of patients.

 

Taken together, these findings suggest that Black patients with CSU may experience a disproportionate burden of uncontrolled disease and may be less likely to access advanced, guideline-recommended therapies relative to other patients.  

Impact of Specialist Care

In addition to variation across racial and insurance subgroups, our analysis identified descriptive differences in treatment patterns based on specialist involvement. We found that patients with both allergist and dermatologist visits received higher proportions of biologic prescriptions as compared with other groups.

Across all specialist groups, high levels of corticosteroid use and acute care utilization persisted, suggesting ongoing unmet need for more effective and guideline-aligned treatment strategies in CSU management.

Our findings suggest that access to specialists – particularly allergists – appears linked to faster and greater use of advanced therapies.

Risks Associated with Corticosteroid Use

Lastly, we examined patterns of systemic corticosteroid use and related outcomes among patients with CSU. We found descriptive evidence that corticosteroid use was associated with the occurrence of adverse events (AEs) such as lipid disorders and hypertension, and prolonged use was generally associated with more frequent AEs and greater AE-related HCRU.

Although clinical guidelines recommend restricting corticosteroids to short-term rescue use, many patients experience prolonged exposure, underscoring the potential clinical and economic consequences of reliance on these therapies and highlighting the importance of equitable access to alternative, advanced treatment options.

Conclusion

Our studies indicate that disparities by race and socioeconomic status exist in the management of patients with CSU. Patients with Medicaid – particularly Black patients – appear more likely to rely on emergency care and corticosteroids, and less likely to receive advanced biologic therapies. At the same time, high levels of steroid use and acute care visits across all populations indicate an unmet need for more effective disease control across patient groups.

Further research in this area is needed to uncover the structural and clinical factors driving disparities and to identify strategies that may help reduce gaps in care. By leveraging the real-world evidence offered by these and other studies, providers, payers, and manufacturers may be better positioned to make treatment decisions and improve equitable access to guideline-recommended therapies for patients with CSU.

 

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Irina Pivneva, Vice President
Jason Doran, Manager
Frédéric Kinkead, Associate

 

Adapted from three research posters presented during the American College of Allergy, Asthma & Immunology (ACAAI) 2025 Annual Scientific Meeting, including:

Racial, Ethnic, And Socioeconomic Disparities in Chronic Spontaneous Urticaria: A United States Claims Database Study (2025), coauthored by Marc A. Riedl, (University of California, San Diego); Dhaval Patil, Jonathan Rodrigues, Merin Kuruvilla, Panagiotis Orfanos, and Tara Raftery (Novartis); Jason Doran, Irina Pivneva, and Frédéric Kinkead (Analysis Group); and Gil Yosipovitch (University of Miami Miller School of Medicine)

Treatment Patterns in Patients With Chronic Spontaneous Urticaria: Results From a US Claims Database Study (2025), coauthored by Marc A. Riedl, (University of California, San Diego); Dhaval Patil, Jonathan Rodrigues, Merin Kuruvilla, Panagiotis Orfanos, and Tara Raftery (Novartis); Jason Doran, Irina Pivneva, and Frédéric Kinkead (Analysis Group); and Gil Yosipovitch (University of Miami Miller School of Medicine)

Adverse Events Associated With Corticosteroid Use in Chronic Spontaneous Urticaria Management (2025), coauthored by Gil Yosipovitch (University of Miami Miller School of Medicine); Dhaval Patil, Jonathan Rodrigues, Merin Kuruvilla, and Tara Raftery (Novartis); Irina Pivneva, Jason Doran, and James Signorovitch (Analysis Group); and Marc A. Riedl, (University of California, San Diego)