How Is the Impact of Chronic Urticaria Compared to Psoriasis on Patients?

Background: Chronic spontaneous (or idiopathic) urticaria (CSU/CIU) represents 66-93% of chronic urticaria cases. There are few comparisons of the impact of CSU/CIU on patients with other dermatological diseases. The study evaluated the burden of illness associated with CSU/CIU relative to psoriasis (PsO) in adults.

Method: Data were collected in the National Health and Wellness Survey (2010, 2011, 2013) in France, Germany, Italy, Spain, and UK from adults with a diagnosis of chronic hives (used as a proxy to CSU/CIU) or PsO. Burden of illness was analyzed for mental component & physical component scores (MCS & PCS) on SF-12v2 (2010, 2011) or SF-36v2 (2013), health utility score (SF-6D), self-reported depression, anxiety and sleep difficulties in the previous 12 months and work productivity and activity impairment (WPAI). Generalized linear regression models with link functions were used to compare outcomes among patients with CSU/CIU vs. PsO overall, as well as CSU/CIU overall vs. mild and moderate-to-severe PsO.

Results: The study included 769 patients with CSU/CIU and 7,857 patients with PsO (5,736 mild, 2,121 moderate-to-severe). CSU/CIU patients had lower (worse) adjusted mean MCS (42.2 vs. 44.6) & PCS (45.2 vs. 46.8) and SF-6D scores (0.65 vs. 0.68;p<0.001 for all). Depression, anxiety and sleep difficulty was higher for CSU/CIU vs. PsO (odds ratio: 1.34, 1.63, 1.56 respectively; p<0.01 for all). Elevated rates of absenteeism, presenteeism and overall work impairment among CSU/CIU patients vs. PsO (rate ratios (RR) =1.31, 1.15, & 1.15) were not statistically significant; activity impairment was significantly greater RR=1.21 (p<0.01). When PsO patients were divided by severity, CSU/CIU patients had significantly lower values on MCS, PCS, and health utility, were more likely to self-report depression, anxiety, and sleep difficulties, and had higher activity impairment relative to mild PsO (all p<0.001). Outcomes of CIU/CSU patients were similar to moderate-to-severe PsO patients, with decrements for MCS (1.1 point) and health utility (0.01 point); both p<0.05.

Conclusion: Burden of disease in patients with CSU/CIU is higher than overall PsO. The impact on mental and physical status and risk of depression, anxiety, and sleep difficulties is higher with CSU/CIU than mild PsO, and similar to moderate-to-severe PsO. Impact on work components is similar, but impact on non-work activities is worse for CSU/CIU patients vs. overall and mild PsO.