# A global perspective on stepping down chronic spontaneous urticaria treatment: Results of the Urticaria Centers of Reference and Excellence SDown‐CSU study

## TL;DR

This study examines how doctors worldwide reduce treatment for chronic spontaneous urticaria and finds a lack of clear guidelines for doing so.

## Contribution

The study provides a global perspective on treatment step-down practices and proposes a step-down algorithm for chronic spontaneous urticaria.

## Key findings

- Most national guidelines lack detailed information on how to step down treatment for chronic spontaneous urticaria.
- A majority of UCAREs step down omalizumab within 6 months of controlled symptoms.
- Only 28% of physicians operate under regulatory guidelines for treatment step-down.

## Abstract

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.