The Effectiveness of Omalizumab Treatment in Real-Life is Lower in Patients with Chronic Urticaria Longer than 18 Months’ Evolution and Prior Immunosuppressive Treatment

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Cubiró, J. Spertino, E. Rozas-Muñoz, E. Serra-Baldrich, L. Puig" "autores" => array:5 [ 0 => array:4 [ "nombre" => "X." "apellidos" => "Cubiró" "email" => array:1 [ 0 => "xcubiro@santpau.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Spertino" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Rozas-Muñoz" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Serra-Baldrich" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Puig" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La efectividad del tratamiento con omalizumab en la vida real es menor en pacientes con urticaria crónica de más de 18 meses de evolución y tratamiento inmunosupresor previo" ] ] "textoCompleto" => "IntroductionChronic spontaneous urticaria (CSU) is a common disease characterized by the spontaneous occurrence of itchy wheals, angioedema, or both, for a period of more than 6 weeks. The condition usually lasts approximately one year in 70% of patients, but it can persist for more than 5 years in up to 15%,<a class="elsevierStyleCrossRef" href="#bib0135">1</a> with a detrimental effect on patient's quality of life.Two drugs are currently approved for the treatment of CSU in Europe and North America: non-sedating H1-antihistamines (anti-H1) and the monoclonal antibody omalizumab. Anti-H1 are safe and cheap and are recommended in the current American and European guidelines for the initial treatment of patients with CSU.<a class="elsevierStyleCrossRefs" href="#bib0140">2,3</a> However, with standard doses, up to 50% of patients<a class="elsevierStyleCrossRef" href="#bib0135">1</a> are unable to achieve a good control of the disease.Omalizumab, a recombinant humanized monoclonal antibody, has shown high efficacy in phase III clinical trials, and is currently approved for the treatment of moderate-to-severe CSU unresponsive to anti-H1. However, there is limited information on the use of omalizumab in real life using the same doses, response evaluation parameters and endpoints that were used in phase III clinical trials.<a class="elsevierStyleCrossRefs" href="#bib0140">2,4,5</a>Disease activity in CSU can be assessed in real practice and in clinical trials with the weekly Urticaria Activity Score (UAS7), a simple scoring system that was proposed in the 2017 version<a class="elsevierStyleCrossRef" href="#bib0160">6</a> of the EAACI/ GA2LEN/ EDF/ WAO guidelines. The patient quantifies the daily number of wheals (range: 0-none to 3-severe) and daily severity of pruritus (range: 0-none to 3-severe) for 7 consecutive days, with a maximum sum score of 42. UAS7 allows comparison of the results from different studies and centers, and is a useful tool for both clinical trials and real life practice.<a class="elsevierStyleCrossRef" href="#bib0165">7</a>Few studies have assessed UAS7 response at weeks 12 and 24 in real life using omalizumab 300mg every 4 weeks.<a class="elsevierStyleCrossRefs" href="#bib0165">7–18</a> Real world and randomized clinical trials outcomes need to be compared because patient populations in both settings may differ; for instance, patients with inducible urticaria or CSU with severe comorbidities (history of cancer, parasitic infection, history of anaphylaxis, pregnancy, previous treatment last 30 days of cyclosporine, etc.) were excluded from clinical trials.<a class="elsevierStyleCrossRefs" href="#bib0140">2,4,5</a>The aim of this study was to assess the effectiveness and safety of omalizumab in real life and compare them with the efficacy and safety reported in clinical trials. We also wanted to identify possible predictors of response to omalizumab.MethodsWe conducted a retrospective review of all patients with moderate- to-severe CSU (UAS≥16) treated with omalizumab from February 2014 to September 2017 at the Department of Dermatology of the Hospital de la Santa Creu i Sant Pau, a University-affiliated referral hospital in Barcelona, Spain. Data were retrieved from the medical records and from a prospective registry started in 2009, which received the approval of our local Ethics Committee (16/049 (OBS)), enrolling all patients starting omalizumab for CSU in our center. Patients’ informed consent was obtained prior to inclusion in the study.In agreement with the summary of product characteristics (SmPC), and the European Guidelines,<a class="elsevierStyleCrossRef" href="#bib0160">6</a> only patients with CSU who did not respond to high doses of anti-H1 (up to 4-fold licensed dose) and received the approved dose of omalizumab (300mg every four weeks) for at least 12 weeks (three doses) were included in this study. Omalizumab was administered by experienced medical and nursing personnel at the day-care hospital facilities.Collected data included patients’ demographics (age, weight, height and body mass index [BMI]), duration of CSU prior to the start of omalizumab treatment, UAS7 value at baseline, week 12 and week 24, use of previous or concomitant immunosuppressants (cyclosporine A, azathioprine, mycophenolate mofetil and/or methotrexate) and other treatments (montelukast), adverse events, concomitant angioedema, concomitant inducible urticaria, and use of corticosteroids. Analytical parameters studied included blood counts and leukocyte counts, standard serum biochemistry determinations, serum C-reactive protein (CRP), total immunoglobulin E and complement (C3 and C4) levels, plasma D dimer levels, antinuclear antibody titres, and anti-thyroid antibody titres. Long-term urticaria was arbitrarily defined at 18 months after statistical analysis and consistent with the median duration of disease in a recently published cohort from Barcelona.<a class="elsevierStyleCrossRef" href="#bib0225">19</a>UAS7 values were recorded twice daily during a week for every patient at baseline, before the start of treatment, and prior to visits corresponding to week 12 and week 24 of treatment. The outcome of treatment was defined according to UAS7 values as “clinical response” (UAS7 ≤6) and “complete response” (UAS7=0), as in published clinical trials.<a class="elsevierStyleCrossRefs" href="#bib0140">2,4,5</a>All adverse events (AEs) were recorded and classified into mild, moderate and severe. All cutaneous reactions that occurred on the injection site without systemic symptoms were considered to be mild AEs; anaphylaxis or death were considered as severe AEs, and all the other AEs related to omalizumab administration were considered to be moderate in severity.Statistical analysisStatistical analysis of data was done using the SPSS 18 statistical package (SPSS Inc., Chicago, IL, USA) software. Chi-squared test with Yates correction was used to compare proportions. Mann-Whitney test was used to compare parametric variables. Linear regression was used to evaluate the correlation of UAS at week 12 and 24 with BMI and age. All tests were two-tailed and a value of p<0.05 was considered statistically significant.ResultsPatients and treatmentsForty-eight patients were included in the study. The baseline characteristics of patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Mean duration of CSU prior to the start of omalizumab treatment was 26.1 months (SD 23.0, median 16, range 2–84). Twenty-four patients (50%) had angioedema, and seventeen patients (35.4%) had inducible chronic urticaria (ten had delayed pressure urticaria, six cholinergic urticaria, four symptomatic dermographism, and unknown physical urticaria in one).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Thirty-one patients (64.6%) received oral corticosteroids, eight (16.7%) montelukast and fifteen (31.3%) an immunosuppressive treatment prior to the start of omalizumab treatment. The use of concomitant corticosteroid and/or immunosuppressive treatment was not dependent on the duration of the disease. Prior immunosuppressive treatments included cyclosporine alone in nine patients, methotrexate alone in one patient, concomitant cyclosporine and methotrexate treatment in two patients, azathioprine in one patient and non-concomitant mycophenolate mofetil and cyclosporine in one patient. All immunosuppressive treatments were stopped at least two weeks prior to the start of omalizumab.During omalizumab treatment patients were asked to continue treatment with anti-H1 if required, but it was stopped due to good control of the disease in 11 (22.9%) of patients, with no evidence of relapse upon discontinuation.EffectivenessAt week 12, 70.8% (34/48) of patients had clinical response (UAS7 ≤6) and 47.9% (23/48) complete response (UAS7=0). Five patients discontinued treatment at week 12 because of therapeutic success (complete response), and their complete response status was maintained by week 24. Two patients stopped treatment due to lack of response at week 12. Fifteen patients who achieved complete response by week 12 maintained their complete response status by week 24, six lost response and two maintained clinical response.. From eleven patients who had “clinical response” but not “complete response” at week 12, six became complete responders at week 24, four lost response and one maintained clinical response. In five patients who did not achieve clinical response at week 12, the dose of omalizumab was increased to 450mg monthly, starting at week 12, and three of them obtained clinical response at week 24. Four of the remaining 9 patients who had no response at week 12 achieved complete response, two achieved clinical response and three remained in the non-responder group. At week 24, 64.6% of patients (31/48) achieved clinical response (58.3% excluding those patients who were up-dosed) and 52.1% (25/48) had complete response.None of the clinical variables and laboratory parameters included in the analysis were associated with the achievement of clinical response or complete response at weeks 12 or 24, with the exception of disease duration, presence of angioedema, previous immunosuppressive treatment and concomitant anti-H1 treatment, as detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Mean duration of disease was shorter in patients who achieved clinical response (UAS7 ≤6) at week 12 (13.5 months vs 42, P<0.015). Patients with long-term urticaria (≥18 months’ duration) were less likely to achieve clinical response (UAS7 ≤6) at week 12 (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.06-0.96 for those with ≥18 months’ duration), but the duration of disease was not predictive of clinical response at week 24 or complete response at either week 12 or week 24.A history of angioedema was associated with a higher probability of complete response only at week 24 (OR 3.33, 95% CI 1.02-10.90). Previous immunosuppressive treatment (cyclosporin in 13 out of 15 patients) was associated with a lower probability of complete response at week 12 (OR 0.27, 95% CI 0.07-1.02). The proportion of patients who continued using anti-H1 treatment was lower among patients who achieved response (OR 0.1 95% CI 0.01-0.88) or complete response (OR 0.25 95% CI 0.06-1.14) at week 24, but this association was not observed at week 12.Safety profileNo serious adverse events (AEs) were reported, and no treatment course had to be discontinued because of AEs. Mild AEs (erythema in the administration site) were reported in two cases and moderate AE (headache and asthenia) was reported by one patient.DiscussionOmalizumab is a monoclonal antibody approved for the treatment of moderate-to-severe CSU. Licensed dosage according to the European Medicines Agency-approved SmPC is 300mg every 4 weeks and 150 and 300mg every 4 weeks according to the Food and Drug Administration label. Patients treated with 300mg show better responses compared to those treated with 75mg and 150mg, and the higher dose is associated with better control of angioedema.<a class="elsevierStyleCrossRef" href="#bib0155">5</a>Previously published real-life studies show marked heterogeneity in comparing the percentage of omalizumab responders. Differences in dosage, definition of response and time point of evaluation are seen compared to clinical trials, as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. Many real-life studies define response as clinical improvement, a subjective criterion that makes comparisons difficult. UAS7 was first used in real-life clinical practice by Metz et al.,<a class="elsevierStyleCrossRef" href="#bib0230">20</a> and other authors<a class="elsevierStyleCrossRefs" href="#bib0170">8,13–15,17,20</a> have subsequently used UAS7=0 (complete response) or UAS7≤6 (response). We agree with the EAACI/GA2LEN/EDF/WAO urticaria guideline<a class="elsevierStyleCrossRef" href="#bib0160">6</a> recommendation that UAS7 should be the standard method of measurement and UAS7=0/UAS7≤6 the criteria of efficacy, as in clinical trials.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Moreover, the evaluation time points in real-life studies have not been specified<a class="elsevierStyleCrossRefs" href="#bib0170">8,9,11,12,14,15,18,20</a> or have differed (i.e. week 4)<a class="elsevierStyleCrossRef" href="#bib0170">8</a> with respect to those used in the main clinical trials,<a class="elsevierStyleCrossRefs" href="#bib0140">2,4,5</a> namely week 12 and week 24. Late response can only be assessed by reporting results at week 24, as in the ASTERIA I and GLACIAL clinical trials<a class="elsevierStyleCrossRefs" href="#bib0150">4,5,8</a> and the real-life study by Büyüköztürk et al..<a class="elsevierStyleCrossRef" href="#bib0170">8</a> However, in none of these studies was any information provided in terms of complete or clinical response, and Büyüköztürk et al. only reported the absolute reduction in UAS7.The response to omalizumab treatment in real-life studies has been shown to be better than in clinical trials,<a class="elsevierStyleCrossRefs" href="#bib0140">2,4,5,7–18,20</a> as detailed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. The clinical response (UAS7 ≤6) and complete response (UAS7=0) rates at week 12 in our cohort were also numerically higher than in the ASTERIA I and II and the GLACIAL clinical trials, but the ‘response’ rates in earlier real-life studies are higher than in our cohort, probably due to the choice of clinical judgement, not UAS7, as outcome measure.<a class="elsevierStyleCrossRefs" href="#bib0170">8,13,15</a> Comparison of response rates at week 24 cannot be made, since both GLACIAL and ASTERIA I only include safety and Itch Severity Scale (ISS) data and ASTERIA II did not include an evaluation at week 24.The mean duration of CSU was much longer in pivotal trials (approximately 7 years (range 6.1 to 7.4) compared to approximately 2 years in our series. This might provide an explanation for differences in response, as suggested by lower response rates at week 12 in patients with longer duration of symptoms in our series.Mean age, baseline UAS7, presence of angioedema, and prior use of corticosteroids do not differ in our cohort with respect to pivotal studies. Patients’ mean body mass index in our cohort was 25.1 (IC 95% 24, 2-26), compared to 29.4, 29.3 and 29.5 in GLACIAL and ASTERIA I and II, respectively. Curto-Barredo et al<a class="elsevierStyleCrossRef" href="#bib0235">21</a> recently identified high BMI as a predictor of partial response to 300mg dose, but good response with updosing. However, we did not find any statistically significant association in our series.According to Maurer et al.,<a class="elsevierStyleCrossRef" href="#bib0135">1</a> inducible urticaria is a negative predictor of response, and it was an exclusion criteria in pivotal trials. Seventeen (35.4%) of our patients had inducible urticaria at some point during the course of their disease, but this was not found to be a prognostic factor regarding response to omalizumab at any time point in our cohort. High baseline UAS7 values were not a negative prognostic factor regarding response to omalizumab, again in contrast with the findings of Maurer et al..<a class="elsevierStyleCrossRef" href="#bib0135">1</a>In our cohort, complete response rates increased with time whereas clinical response rates decreased from week 12 to week 24. Some patients with clinical response at week 12 lost this status by week 24. On the other hand, complete response status tended to be consistent over time; 25 out of 48 patients maintained their complete response status from week 12 to week 24, including 5 patients who stopped treatment at week 12 because of complete response.Presence of angioedema has also been associated with a decreased therapeutic response to omalizumab.<a class="elsevierStyleCrossRef" href="#bib0135">1</a> In our real-life cohort, a history of angioedema was associated with a higher probability of complete response at week 24; no significant associations were found at other time points and with clinical response. However, the limitations of UAS7 to assess angioedema may influence this result. Otherwise, our data are consistent with those of Tonacci et al,<a class="elsevierStyleCrossRef" href="#bib0240">22</a> who found clinical response to omalizumab treatment in patients with CSU to be independent of disease severity or IgE levels at baseline.Regarding prior treatment of CSU, ASTERIA studies included only approved doses of anti-H1 as background therapy, whereas the GLACIAL study permitted higher doses of anti-H1 as well as other types of background therapy. In a post-hoc analysis, the intensity of prior treatment has not been found to influence the response to omalizumab,<a class="elsevierStyleCrossRef" href="#bib0240">22</a> in agreement with our cohort data. On the other hand, the odds of achieving complete response at week 12 were close to 4:1 for patients who had not been previously treated with immunosuppressive agents. Previous treatment with immunosuppressive agents was common in our population (31.3% versus 9.5% in the GLACIAL study), and a trend has been previously reported for immunosuppressant-naïve patients to present a better response to omalizumab,<a class="elsevierStyleCrossRef" href="#bib0200">14</a> which is consistent with our results.Limitations of this study are its observational nature, without a control group, measurement scale limitations and the small sample size compared to pivotal trials.In conclusion, this retrospective review of a cohort of 48 consecutive patients treated with omalizumab 300mg every 4 weeks for at least 12 weeks in real life practice shows numerically better response rates than randomized clinical trials at week 12.<a class="elsevierStyleCrossRefs" href="#bib0140">2,4,5</a> At week 24, more than 50% of patients had complete response as defined by UAS 7. Long term (≥18 months) duration of CSU was associated with a lower probability of response to omalizumab at different time points. A similar tendency was observed for previous immunosuppressive treatment. The safety profile of omalizumab in our cohort was consistent with randomized clinical trials, with minimal, tolerable and infrequent side effects.Further studies will be needed to confirm our results and their applicability to other patient populations.Conflicts of interestX. Cubiró and E. Rozas-Muñoz declare no conflicts of interest. L. Puig, E. Serra-Baldrich and J Spertino have received speaker's honoraria and have participated in clinical trials sponsored by Novartis" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1187725" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1107572" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1187724" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1107573" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Patients and treatments" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Effectiveness" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Safety profile" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack405584" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-21" "fechaAceptado" => "2018-09-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1107572" "palabras" => array:5 [ 0 => "Chronic spontaneous urticaria" 1 => "Prediction" 2 => "Omalizumab" 3 => "Real life" 4 => "Urticaria" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1107573" "palabras" => array:5 [ 0 => "Urticaria crónica espontánea" 1 => "Predicción" 2 => "Omalizumab" 3 => "Vida real" 4 => "Urticaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundThe efficacy of omalizumab in the treatment of chronic spontaneous urticaria has been demonstrated in phase iii clinical trials, but limited information is available regarding real-life effectiveness using the weekly Urticarial Activity Score (UAS7). The aim of the study was to assess clinical response (UAS7≤6) and complete response (UAS7=0) rates at weeks 12 and 24 in a real-life cohort and to identify possible predictors of response to omalizumab. MethodsClinical records of consecutive patients with moderate-to-severe chronic spontaneous urticaria (UAS≥16) treated with omalizumab at a university-affiliated reference dermatology department in Barcelona, Spain, from February 2014 to September 2017 were retrospectively reviewed. UAS7 values and patients’ evolution were assessed according to a predefined protocol. Statistical analysis of data was done using SPSS 18 statistical package (SPSS 18 Inc., Chicago, IL, USA) software. ResultsForty-eight patients were included in the study. All of them completed at least 24-weeks of treatment and follow-up. At week 12, clinical response rates (UAS7<6) were 70.8% and complete response rates (UAS7=0) were 47.9%. At week 24, clinical response rates were 64.6% and complete response rates were 52.1%. Patientswith long-term urticaria (≥18 months’ duration) were less likely to achieve a clinical response at week 12 (odds ratio: 0.25; 95% confidence interval 0.06-0.96). Previous immunosuppressive treatment tended to be associated with a lower probability of complete response at week 12 (odds ratio: 0.27 95% confidence interval: 0.07-1.02). H1-antihistamine treatment was associated with lower probability of response at week 24 (odds ratio: 0.1 95% 95% confidence interval: 0.01-0.88) ConclusionsThe effectiveness and safety of omalizumab in real life are similar to efficacy and safety in clinical trials. Duration of disease, previous immunosuppressive therapy and requirement for concomitant H1-antihistamine treatment may be helpful in predicting response to omalizumab treatment." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesAunque la eficacia del omalizumab en el tratamiento de la urticaria crónica espontánea está demostrada en ensayos clínicos de fase iii, la información disponible sobre la efectividad en la vida real utilizando la puntuación de actividad urticarial semanal (UAS7) es escasa. El objetivo del estudio fue evaluar la respuesta clínica (UAS7≤6) y la respuesta completa (UAS7=0) en las semanas 12 y 24 en una cohorte de la vida real e identificar posibles predictores de respuesta al omalizumab. MétodosSe llevó a cabo una revisión retrospectiva de los registros clínicos de pacientes consecutivos con urticaria crónica espontánea de moderada a grave (UAS≥16) tratados con omalizumab en el Servicio de Dermatología de un hospital universitario en Barcelona, España, desde febrero de 2014 a septiembre de 2017. Se evaluaron los valores de UAS7 y la evolución siguiendo un protocolo predefinido. El análisis estadístico de los datos se realizó utilizando el paquete estadístico SPSS 18 (SPSS 18 Inc., Chicago, IL, EE. UU.). ResultadosSe incluyeron en el estudio 48 pacientes, que completaron 24 semanas de seguimiento. Las tasas de respuesta clínica (UAS7<6) y completa (UAS7=0) fueron del 70,8% y del 47,9% a la semana 12 y del 64,6% y del 52,1% a la semana 24.Los pacientes con urticaria de larga duración (≥18 meses) tuvieron menor probabilidad de lograr una respuesta clínica en la semana 12 (odds ratio: 0,25; intervalo de confianza del 95%: 0,06-0,96). El tratamiento inmunosupresor previo tendía a asociarse con una menor probabilidad de respuesta completa en la semana 12 (odds ratio: 0,27; intervalo de confianza del 95%: 0,07-1,02). El tratamiento con antihistamínicos H1 se asoció con una menor probabilidad de respuesta a la semana 24 (odds ratio: 0,1; intervalo de confianza del 95%: 0,01-0,88). ConclusionesLa eficiencia y la seguridad del omalizumab en la vida real son similares a la eficacia y la seguridad en los ensayos clínicos. La duración de la enfermedad, la terapia inmunosupresora previa y el requerimiento de tratamiento concomitante con antihistamínicos H1 pueden ayudar a predecir la respuesta al tratamiento con omalizumab." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Cubiró X, Spertino J, Rozas-Muñoz E, Serra-Baldrich E, Puig L. The Effectiveness of Omalizumab Treatment in Real-Life is Lower in Patients with Chronic Urticaria Longer than 18 Months’ Evolution and Prior Immunosuppressive Treatment. Actas Dermosifiliogr. 2019;110:289–296." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "DE: desviación estándar; IMC: índice de masa corporal; UAS7: puntuación de actividad urticarial semanal; UCE: urticaria crónica espontánea." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N= 48 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Gender</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (66.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Age (SD)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD, range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.2 (16.7, range 16–76) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">BMI</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.1 (3,1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Duration of CSU (months)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.1 (23.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>18 Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (47.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>24 Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (35.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Presence of angioedema</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (50.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Previous use of corticosteroids</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">YES \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (64.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Previous immunosuppressant treatment</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">YES \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (31.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Previous montelukast treatment</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">YES \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Inducible urticaria</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">YES \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (35,4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Baseline UAS7 (mean)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 (8,1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Concomitant antihistaminics</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">YES \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (77.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2026144.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of patients." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "S12/24: semana 12 y 24; UAS7: puntuación de actividad urticarial semanal; UCE: urticaria crónica espontánea." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="6" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical responders (UAS7<6)</th><th class="td" title="table-head " colspan="6" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complete responders (UAS7=0)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">W12</th><th class="td" title="table-head " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">W24</th><th class="td" title="table-head " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">W12</th><th class="td" title="table-head " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">W24</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20.0/13.5/17.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.9/42/27.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>18 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13(34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10(14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.036 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Angioedema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (65) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (33,3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.063 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Immunosuppresant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.065 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antihistamines-H1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15(30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15(18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.028 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12(20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18(21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.065 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2026143.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "wk: week; NS: not stated; UAS7 90: ≥90% reduction of UAS7 with respect to baseline; mg: milligrams; CSU/CindU: Chronic spontaneous urticaria/chronic induced urticaria" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3Randomized controlled trials \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients (n) (CSU/CIndU) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose (mg) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Response rate (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Response definition \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Efficacy/ effectiveness evaluation (wk) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">X-CUISITE, 2014<a class="elsevierStyleCrossRef" href="#bib0245">23</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49 (49/0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75–375/2-4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">MYSTIQUE, 2011<a class="elsevierStyleCrossRef" href="#bib0250">24</a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">90 (69/21)</td><td class="td" title="table-entry " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7 90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">ASTERIA I, 2015<a class="elsevierStyleCrossRef" href="#bib0150">4</a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">318 (238/80)</td><td class="td" title="table-entry " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51.9/35.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7≤6/ UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 and 24 (not available) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">150/4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7≤6/ UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 and 24 (not available) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">ASTERIA II, 2013<a class="elsevierStyleCrossRef" href="#bib0140">2</a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">323 (244/79)</td><td class="td" title="table-entry " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65.8/53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7≤6/ UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">150/4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7≤6/ UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GLACIAL, 2013 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">336 (252/84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52.4/33.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7≤6/ UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">X-ACT, 2016<a class="elsevierStyleCrossRef" href="#bib0255">25</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91 (44/47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Michihiro et al., 2017 (Japan and Korea)<a class="elsevierStyleCrossRef" href="#bib0260">26</a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">268 (268/0)</td><td class="td" title="table-entry " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ISS7 and UAS7≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">150/ 4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ISS7 and UAS7≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Büyüköztürk, 2012 (Turkey)<a class="elsevierStyleCrossRef" href="#bib0170">8</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (12/0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150-300/2-4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS score and QoL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 and 24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Labrador-Horrillo, 2013 (Spain)<a class="elsevierStyleCrossRef" href="#bib0175">9</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">110 (110/0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150-300/2-4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical judgement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Armengot-Carbo et al., 2013 (Spain)<a class="elsevierStyleCrossRef" href="#bib0180">10</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (15/0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150-300/2-4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical judgement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metz et al., 2014 (Germany)<a class="elsevierStyleCrossRef" href="#bib0230">20</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51 (20/31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150–300 /2-4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7 90 + no antihistamines \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Rottem et al., 2014 (Israel)<a class="elsevierStyleCrossRef" href="#bib0185">11</a></td><td class="td" title="table-entry " align="left" valign="top">13 (13/0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">300/ 4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical judgement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">30 (30/0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150/ 4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical judgement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sussman et al., 2014 (Canada)<a class="elsevierStyleCrossRef" href="#bib0190">12</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68 (61/7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150/ 4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Various \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clark et al., 2016 (USA)<a class="elsevierStyleCrossRef" href="#bib0195">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (43/5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150-300/ 2-4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical judgement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Giménez-Arnau et al., 2016 (Spain)<a class="elsevierStyleCrossRef" href="#bib0165">7</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (38/0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">300/ 4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ghazanfar et al., 2016 (Denmark)<a class="elsevierStyleCrossRef" href="#bib0200">14</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">154 (137/17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150/2wk-300/ 4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical judgement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Ensina et al., 2016 (Brazil)<a class="elsevierStyleCrossRef" href="#bib0205">15</a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">47 (47/0)</td><td class="td" title="table-entry " align="left" valign="top">150/ 4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical judgement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical judgement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gericke et al., 2016 (Germany)<a class="elsevierStyleCrossRef" href="#bib0210">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 (64/0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wilches et al., 2016 (Ecuador) (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (26/0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150/ 4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7≤1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kulthanan et al., 2016 (Thailand)<a class="elsevierStyleCrossRef" href="#bib0220">18</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (12/1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150-300/4wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Various \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Present cohort (Spain) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (44/4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">300/4 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70.8/47.9 (wk12) 64.6/52.1 (wk24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UAS7≤6/ UAS7=0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 and 24 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2026142.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Omalizumab clinical trials and real-life studies." ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unmet clinical needs in chronic spontaneous urticaria. 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Original Article

The Effectiveness of Omalizumab Treatment in Real-Life is Lower in Patients with Chronic Urticaria Longer than 18 Months’ Evolution and Prior Immunosuppressive Treatment

La efectividad del tratamiento con omalizumab en la vida real es menor en pacientes con urticaria crónica de más de 18 meses de evolución y tratamiento inmunosupresor previo

X. Cubiró

Corresponding author

xcubiro@santpau.cat

Corresponding author.

, J. Spertino, E. Rozas-Muñoz, E. Serra-Baldrich, L. Puig

Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España

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with standard doses&#44; up to 50&#37; of patients<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> are unable to achieve a good control of the disease&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Omalizumab&#44; a recombinant humanized monoclonal antibody&#44; has shown high efficacy in phase III clinical trials&#44; and is currently approved for the treatment of moderate-to-severe CSU unresponsive to anti-H1&#46; However&#44; there is limited information on the use of omalizumab in real life using the same doses&#44; response evaluation parameters and endpoints that were used in phase III clinical trials&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Disease activity in CSU&#160;can&#160;be assessed&#160;in&#160;real practice&#160;and&#160;in clinical&#160;trials with the&#160;weekly Urticaria&#160;Activity Score &#40;UAS7&#41;&#44; a simple scoring system that was proposed in the 2017 version<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> of the EAACI&#47; GA2LEN&#47; EDF&#47; WAO guidelines&#46; The patient quantifies the daily number of wheals &#40;range&#58; 0-none to 3-severe&#41; and daily severity of pruritus &#40;range&#58; 0-none to 3-severe&#41; for 7 consecutive days&#44; with a maximum sum score of 42&#46; UAS7 allows comparison of the results from different studies and centers&#44; and is a useful tool for both clinical trials and real life practice&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Few studies have assessed UAS7 response at weeks 12 and 24 in real life using omalizumab 300<span class="elsevierStyleHsp" style=""></span>mg every 4 weeks&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7&#8211;18</span></a> Real world and randomized clinical trials outcomes need to be compared because patient populations in both settings may differ&#59; for instance&#44; patients with inducible urticaria or CSU with severe comorbidities &#40;history of cancer&#44; parasitic infection&#44; history of anaphylaxis&#44; pregnancy&#44; previous treatment last 30 days of cyclosporine&#44; etc&#46;&#41; were excluded from clinical trials&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this study was to assess the effectiveness and safety of omalizumab in real life and compare them with the efficacy and safety reported in clinical trials&#46; We also wanted to identify possible predictors of response to omalizumab&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We conducted a retrospective review of all patients with moderate- to-severe CSU &#40;UAS&#8805;16&#41; treated with omalizumab from February 2014 to September 2017 at the Department of Dermatology of the Hospital de la Santa Creu i Sant Pau&#44; a University-affiliated referral hospital in Barcelona&#44; Spain&#46; Data were retrieved from the medical records and from a prospective registry started in 2009&#44; which received the approval of our local Ethics Committee &#40;16&#47;049 &#40;OBS&#41;&#41;&#44; enrolling all patients starting omalizumab for CSU in our center&#46; Patients&#8217; informed consent was obtained prior to inclusion in the study&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In agreement with the summary of product characteristics &#40;SmPC&#41;&#44; and the European Guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> only patients with CSU who did not respond to high doses of anti-H1 &#40;up to 4-fold licensed dose&#41; and received the approved dose of omalizumab &#40;300<span class="elsevierStyleHsp" style=""></span>mg every four weeks&#41; for at least 12 weeks &#40;three doses&#41; were included in this study&#46; Omalizumab was administered by experienced medical and nursing personnel at the day-care hospital facilities&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Collected data included patients&#8217; demographics &#40;age&#44; weight&#44; height and body mass index &#91;BMI&#93;&#41;&#44; duration of CSU prior to the start of omalizumab treatment&#44; UAS7 value at baseline&#44; week 12 and week 24&#44; use of previous or concomitant immunosuppressants &#40;cyclosporine A&#44; azathioprine&#44; mycophenolate mofetil and&#47;or methotrexate&#41; and other treatments &#40;montelukast&#41;&#44; adverse events&#44; concomitant angioedema&#44; concomitant inducible urticaria&#44; and use of corticosteroids&#46; Analytical parameters studied included blood counts and leukocyte counts&#44; standard serum biochemistry determinations&#44; serum C-reactive protein &#40;CRP&#41;&#44; total immunoglobulin E and complement &#40;C3 and C4&#41; levels&#44; plasma D dimer levels&#44; antinuclear antibody titres&#44; and anti-thyroid antibody titres&#46; Long-term urticaria was arbitrarily defined at 18 months after statistical analysis and consistent with the median duration of disease in a recently published cohort from Barcelona&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">UAS7 values were recorded twice daily during a week for every patient at baseline&#44; before the start of treatment&#44; and prior to visits corresponding to week 12 and week 24 of treatment&#46; The outcome of treatment was defined according to UAS7 values as &#8220;clinical response&#8221; &#40;UAS7 &#8804;6&#41; and &#8220;complete response&#8221; &#40;UAS7&#61;0&#41;&#44; as in published clinical trials&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">All adverse events &#40;AEs&#41; were recorded and classified into mild&#44; moderate and severe&#46; All cutaneous reactions that occurred on the injection site without systemic symptoms were considered to be mild AEs&#59; anaphylaxis or death were considered as severe AEs&#44; and all the other AEs related to omalizumab administration were considered to be moderate in severity&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical analysis of data was done using the SPSS 18 statistical package &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41; software&#46; Chi-squared test with Yates correction was used to compare proportions&#46; Mann-Whitney test was used to compare parametric variables&#46; Linear regression was used to evaluate the correlation of UAS at week 12 and 24 with BMI and age&#46; All tests were two-tailed and a value of p&#60;0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patients and treatments</span><p id="par0065" class="elsevierStylePara elsevierViewall">Forty-eight patients were included in the study&#46; The baseline characteristics of patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Mean duration of CSU prior to the start of omalizumab treatment was 26&#46;1 months &#40;SD 23&#46;0&#44; median 16&#44; range 2&#8211;84&#41;&#46; Twenty-four patients &#40;50&#37;&#41; had angioedema&#44; and seventeen patients &#40;35&#46;4&#37;&#41; had inducible chronic urticaria &#40;ten had delayed pressure urticaria&#44; six cholinergic urticaria&#44; four symptomatic dermographism&#44; and unknown physical urticaria in one&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Thirty-one patients &#40;64&#46;6&#37;&#41; received oral corticosteroids&#44; eight &#40;16&#46;7&#37;&#41; montelukast and fifteen &#40;31&#46;3&#37;&#41; an immunosuppressive treatment prior to the start of omalizumab treatment&#46; The use of concomitant corticosteroid and&#47;or immunosuppressive treatment was not dependent on the duration of the disease&#46; Prior immunosuppressive treatments included cyclosporine alone in nine patients&#44; methotrexate alone in one patient&#44; concomitant cyclosporine and methotrexate treatment in two patients&#44; azathioprine in one patient and non-concomitant mycophenolate mofetil and cyclosporine in one patient&#46; All immunosuppressive treatments were stopped at least two weeks prior to the start of omalizumab&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">During omalizumab treatment patients were asked to continue treatment with anti-H1 if required&#44; but it was stopped due to good control of the disease in 11 &#40;22&#46;9&#37;&#41; of patients&#44; with no evidence of relapse upon discontinuation&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Effectiveness</span><p id="par0080" class="elsevierStylePara elsevierViewall">At week 12&#44; 70&#46;8&#37; &#40;34&#47;48&#41; of patients had clinical response &#40;UAS7 &#8804;6&#41; and 47&#46;9&#37; &#40;23&#47;48&#41; complete response &#40;UAS7&#61;0&#41;&#46; Five patients discontinued treatment at week 12 because of therapeutic success &#40;complete response&#41;&#44; and their complete response status was maintained by week 24&#46; Two patients stopped treatment due to lack of response at week 12&#46; Fifteen patients who achieved complete response by week 12 maintained their complete response status by week 24&#44; six lost response and two maintained clinical response&#46;&#46; From eleven patients who had &#8220;clinical response&#8221; but not &#8220;complete response&#8221; at week 12&#44; six became complete responders at week 24&#44; four lost response and one maintained clinical response&#46; In five patients who did not achieve clinical response at week 12&#44; the dose of omalizumab was increased to 450<span class="elsevierStyleHsp" style=""></span>mg monthly&#44; starting at week 12&#44; and three of them obtained clinical response at week 24&#46; Four of the remaining 9 patients who had no response at week 12 achieved complete response&#44; two achieved clinical response and three remained in the non-responder group&#46; At week 24&#44; 64&#46;6&#37; of patients &#40;31&#47;48&#41; achieved clinical response &#40;58&#46;3&#37; excluding those patients who were up-dosed&#41; and 52&#46;1&#37; &#40;25&#47;48&#41; had complete response&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">None of the clinical variables and laboratory parameters included in the analysis were associated with the achievement of clinical response or complete response at weeks 12 or 24&#44; with the exception of disease duration&#44; presence of angioedema&#44; previous immunosuppressive treatment and concomitant anti-H1 treatment&#44; as detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Mean duration of disease was shorter in patients who achieved clinical response &#40;UAS7 &#8804;6&#41; at week 12 &#40;13&#46;5 months vs 42&#44; P&#60;0&#46;015&#41;&#46; Patients with long-term urticaria &#40;&#8805;18 months&#8217; duration&#41; were less likely to achieve clinical response &#40;UAS7 &#8804;6&#41; at week 12 &#40;odds ratio &#91;OR&#93; 0&#46;25&#44; 95&#37; confidence interval &#91;CI&#93; 0&#46;06-0&#46;96 for those with &#8805;18 months&#8217; duration&#41;&#44; but the duration of disease was not predictive of clinical response at week 24 or complete response at either week 12 or week 24&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A history of angioedema was associated with a higher probability of complete response only at week 24 &#40;OR 3&#46;33&#44; 95&#37; CI 1&#46;02-10&#46;90&#41;&#46; Previous immunosuppressive treatment &#40;cyclosporin in 13 out of 15 patients&#41; was associated with a lower probability of complete response at week 12 &#40;OR 0&#46;27&#44; 95&#37; CI 0&#46;07-1&#46;02&#41;&#46; The proportion of patients who continued using anti-H1 treatment was lower among patients who achieved response &#40;OR 0&#46;1 95&#37; CI 0&#46;01-0&#46;88&#41; or complete response &#40;OR 0&#46;25 95&#37; CI 0&#46;06-1&#46;14&#41; at week 24&#44; but this association was not observed at week 12&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Safety profile</span><p id="par0100" class="elsevierStylePara elsevierViewall">No serious adverse events &#40;AEs&#41; were reported&#44; and no treatment course had to be discontinued because of AEs&#46; Mild AEs &#40;erythema in the administration site&#41; were reported in two cases and moderate AE &#40;headache and asthenia&#41; was reported by one patient&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Omalizumab is a monoclonal antibody approved for the treatment of moderate-to-severe CSU&#46; Licensed dosage according to the European Medicines Agency-approved SmPC is 300<span class="elsevierStyleHsp" style=""></span>mg every 4 weeks and 150 and 300<span class="elsevierStyleHsp" style=""></span>mg every 4 weeks according to the Food and Drug Administration label&#46; Patients treated with 300<span class="elsevierStyleHsp" style=""></span>mg show better responses compared to those treated with 75<span class="elsevierStyleHsp" style=""></span>mg and 150<span class="elsevierStyleHsp" style=""></span>mg&#44; and the higher dose is associated with better control of angioedema&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Previously published real-life studies show marked heterogeneity in comparing the percentage of omalizumab responders&#46; Differences in dosage&#44; definition of response and time point of evaluation are seen compared to clinical trials&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Many real-life studies define response as clinical improvement&#44; a subjective criterion that makes comparisons difficult&#46; UAS7 was first used in real-life clinical practice by Metz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> and other authors<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#44;13&#8211;15&#44;17&#44;20</span></a> have subsequently used UAS7&#61;0 &#40;complete response&#41; or UAS7&#8804;6 &#40;response&#41;&#46; We agree with the EAACI&#47;GA2LEN&#47;EDF&#47;WAO urticaria guideline<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> recommendation that UAS7 should be the standard method of measurement and UAS7&#61;0&#47;UAS7&#8804;6 the criteria of efficacy&#44; as in clinical trials&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Moreover&#44; the evaluation time points in real-life studies have not been specified<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#44;9&#44;11&#44;12&#44;14&#44;15&#44;18&#44;20</span></a> or have differed &#40;i&#46;e&#46; week 4&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> with respect to those used in the main clinical trials&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a> namely week 12 and week 24&#46; Late response can only be assessed by reporting results at week 24&#44; as in the ASTERIA I and GLACIAL clinical trials<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#44;5&#44;8</span></a> and the real-life study by B&#252;y&#252;k&#246;zt&#252;rk et al&#46;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> However&#44; in none of these studies was any information provided in terms of complete or clinical response&#44; and B&#252;y&#252;k&#246;zt&#252;rk et al&#46; only reported the absolute reduction in UAS7&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The response to omalizumab treatment in real-life studies has been shown to be better than in clinical trials&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;4&#44;5&#44;7&#8211;18&#44;20</span></a> as detailed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; The clinical response &#40;UAS7 &#8804;6&#41; and complete response &#40;UAS7&#61;0&#41; rates at week 12 in our cohort were also numerically higher than in the ASTERIA I and II and the GLACIAL clinical trials&#44; but the &#8216;response&#8217; rates in earlier real-life studies are higher than in our cohort&#44; probably due to the choice of clinical judgement&#44; not UAS7&#44; as outcome measure&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#44;13&#44;15</span></a> Comparison of response rates at week 24 cannot be made&#44; since both GLACIAL and ASTERIA I only include safety and Itch&#160;Severity Scale &#40;ISS&#41; data and ASTERIA II did not include an evaluation at week 24&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The mean duration of CSU was much longer in pivotal trials &#40;approximately 7 years &#40;range 6&#46;1 to 7&#46;4&#41; compared to approximately 2 years in our series&#46; This might provide an explanation for differences in response&#44; as suggested by lower response rates at week 12 in patients with longer duration of symptoms in our series&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Mean age&#44; baseline UAS7&#44; presence of angioedema&#44; and prior use of corticosteroids do not differ in our cohort with respect to pivotal studies&#46; Patients&#8217; mean body mass index in our cohort was 25&#46;1 &#40;IC 95&#37; 24&#44; 2-26&#41;&#44; compared to 29&#46;4&#44; 29&#46;3 and 29&#46;5 in GLACIAL and ASTERIA I and II&#44; respectively&#46; Curto-Barredo et al<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> recently identified high BMI as a predictor of partial response to 300<span class="elsevierStyleHsp" style=""></span>mg dose&#44; but good response with updosing&#46; However&#44; we did not find any statistically significant association in our series&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">According to Maurer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> inducible urticaria is a negative predictor of response&#44; and it was an exclusion criteria in pivotal trials&#46; Seventeen &#40;35&#46;4&#37;&#41; of our patients had inducible urticaria at some point during the course of their disease&#44; but this was not found to be a prognostic factor regarding response to omalizumab at any time point in our cohort&#46; High baseline UAS7 values were not a negative prognostic factor regarding response to omalizumab&#44; again in contrast with the findings of Maurer et al&#46;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In our cohort&#44; complete response rates increased with time whereas clinical response rates decreased from week 12 to week 24&#46; Some patients with clinical response at week 12 lost this status by week 24&#46; On the other hand&#44; complete response status tended to be consistent over time&#59; 25 out of 48 patients maintained their complete response status from week 12 to week 24&#44; including 5 patients who stopped treatment at week 12 because of complete response&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Presence of angioedema has also been associated with a decreased therapeutic response to omalizumab&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> In our real-life cohort&#44; a history of angioedema was associated with a higher probability of complete response at week 24&#59; no significant associations were found at other time points and with clinical response&#46; However&#44; the limitations of UAS7 to assess angioedema may influence this result&#46; Otherwise&#44; our data are consistent with those of Tonacci et al&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> who found clinical response to omalizumab treatment in patients with CSU to be independent of disease severity or IgE levels at baseline&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Regarding prior treatment of CSU&#44; ASTERIA studies included only approved doses of anti-H1 as background therapy&#44; whereas the GLACIAL study permitted higher doses of anti-H1 as well as other types of background therapy&#46; In a post-hoc analysis&#44; the intensity of prior treatment has not been found to influence the response to omalizumab&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> in agreement with our cohort data&#46; On the other hand&#44; the odds of achieving complete response at week 12 were close to 4&#58;1 for patients who had not been previously treated with immunosuppressive agents&#46; Previous treatment with immunosuppressive agents was common in our population &#40;31&#46;3&#37; versus 9&#46;5&#37; in the GLACIAL study&#41;&#44; and a trend has been previously reported for immunosuppressant-na&#239;ve patients to present a better response to omalizumab&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> which is consistent with our results&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Limitations of this study are its observational nature&#44; without a control group&#44; measurement scale limitations and the small sample size compared to pivotal trials&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion&#44; this retrospective review of a cohort of 48 consecutive patients treated with omalizumab 300<span class="elsevierStyleHsp" style=""></span>mg every 4 weeks for at least 12 weeks in real life practice shows numerically better response rates than randomized clinical trials at week 12&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a> At week 24&#44; more than 50&#37; of patients had complete response as defined by UAS 7&#46; Long term &#40;&#8805;18 months&#41; duration of CSU was associated with a lower probability of response to omalizumab at different time points&#46; A similar tendency was observed for previous immunosuppressive treatment&#46; The safety profile of omalizumab in our cohort was consistent with randomized clinical trials&#44; with minimal&#44; tolerable and infrequent side effects&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Further studies will be needed to confirm our results and their applicability to other patient populations&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">X&#46; Cubir&#243; and E&#46; Rozas-Mu&#241;oz declare no conflicts of interest&#46; L&#46; Puig&#44; E&#46; Serra-Baldrich and J Spertino have received speaker&#39;s honoraria and have participated in clinical trials sponsored by Novartis</p></span></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The efficacy of omalizumab in the treatment of chronic spontaneous urticaria has been demonstrated in phase <span class="elsevierStyleSmallCaps">iii</span> clinical trials&#44; but limited information is available regarding real-life effectiveness using the weekly Urticarial Activity Score &#40;UAS7&#41;&#46; The aim of the study was to assess clinical response &#40;UAS7<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6&#41; and complete response &#40;UAS7<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41; rates at weeks 12 and 24 in a real-life cohort and to identify possible predictors of response to omalizumab&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical records of consecutive patients with moderate-to-severe chronic spontaneous urticaria &#40;UAS<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>16&#41; treated with omalizumab at a university-affiliated reference dermatology department in Barcelona&#44; Spain&#44; from February 2014 to September 2017 were retrospectively reviewed&#46; UAS7 values and patients&#8217; evolution were assessed according to a predefined protocol&#46; Statistical analysis of data was done using SPSS 18 statistical package &#40;SPSS 18 Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41; software&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Forty-eight patients were included in the study&#46; All of them completed at least 24-weeks of treatment and follow-up&#46; At week 12&#44; clinical response rates &#40;UAS7<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>6&#41; were 70&#46;8&#37; and complete response rates &#40;UAS7<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41; were 47&#46;9&#37;&#46; At week 24&#44; clinical response rates were 64&#46;6&#37; and complete response rates were 52&#46;1&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">with long-term urticaria &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>18 months&#8217; duration&#41; were less likely to achieve a clinical response at week 12 &#40;odds ratio&#58; 0&#46;25&#59; 95&#37; confidence interval 0&#46;06-0&#46;96&#41;&#46; Previous immunosuppressive treatment tended to be associated with a lower probability of complete response at week 12 &#40;odds ratio&#58; 0&#46;27 95&#37; confidence interval&#58; 0&#46;07-1&#46;02&#41;&#46; H1-antihistamine treatment was associated with lower probability of response at week 24 &#40;odds ratio&#58; 0&#46;1 95&#37; 95&#37; confidence interval&#58; 0&#46;01-0&#46;88&#41;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The effectiveness and safety of omalizumab in real life are similar to efficacy and safety in clinical trials&#46; Duration of disease&#44; previous immunosuppressive therapy and requirement for concomitant H1-antihistamine treatment may be helpful in predicting response to omalizumab treatment&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Patients"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Aunque la eficacia del omalizumab en el tratamiento de la urticaria cr&#243;nica espont&#225;nea est&#225; demostrada en ensayos cl&#237;nicos de fase <span class="elsevierStyleSmallCaps">iii</span>&#44; la informaci&#243;n disponible sobre la efectividad en la vida real utilizando la puntuaci&#243;n de actividad urticarial semanal &#40;UAS7&#41; es escasa&#46; El objetivo del estudio fue evaluar la respuesta cl&#237;nica &#40;UAS7<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6&#41; y la respuesta completa &#40;UAS7<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41; en las semanas 12 y 24 en una cohorte de la vida real e identificar posibles predictores de respuesta al omalizumab&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se llev&#243; a cabo una revisi&#243;n retrospectiva de los registros cl&#237;nicos de pacientes consecutivos con urticaria cr&#243;nica espont&#225;nea de moderada a grave &#40;UAS<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>16&#41; tratados con omalizumab en el Servicio de Dermatolog&#237;a de un hospital universitario en Barcelona&#44; Espa&#241;a&#44; desde febrero de 2014 a septiembre de 2017&#46; Se evaluaron los valores de UAS7 y la evoluci&#243;n siguiendo un protocolo predefinido&#46; El an&#225;lisis estad&#237;stico de los datos se realiz&#243; utilizando el paquete estad&#237;stico SPSS 18 &#40;SPSS 18 Inc&#46;&#44; Chicago&#44; IL&#44; EE&#46; UU&#46;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el estudio 48 pacientes&#44; que completaron 24 semanas de seguimiento&#46; Las tasas de respuesta cl&#237;nica &#40;UAS7<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>6&#41; y completa &#40;UAS7<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41; fueron del 70&#44;8&#37; y del 47&#44;9&#37; a la semana 12 y del 64&#44;6&#37; y del 52&#44;1&#37; a la semana 24&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con urticaria de larga duraci&#243;n &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>18 meses&#41; tuvieron menor probabilidad de lograr una respuesta cl&#237;nica en la semana 12 &#40;odds ratio&#58; 0&#44;25&#59; intervalo de confianza del 95&#37;&#58; 0&#44;06-0&#44;96&#41;&#46; El tratamiento inmunosupresor previo tend&#237;a a asociarse con una menor probabilidad de respuesta completa en la semana 12 &#40;odds ratio&#58; 0&#44;27&#59; intervalo de confianza del 95&#37;&#58; 0&#44;07-1&#44;02&#41;&#46; El tratamiento con antihistam&#237;nicos H1 se asoci&#243; con una menor probabilidad de respuesta a la semana 24 &#40;odds ratio&#58; 0&#44;1&#59; intervalo de confianza del 95&#37;&#58; 0&#44;01-0&#44;88&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La eficiencia y la seguridad del omalizumab en la vida real son similares a la eficacia y la seguridad en los ensayos cl&#237;nicos&#46; La duraci&#243;n de la enfermedad&#44; la terapia inmunosupresora previa y el requerimiento de tratamiento concomitante con antihistam&#237;nicos H1 pueden ayudar a predecir la respuesta al tratamiento con omalizumab&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Antecedentes"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Cubir&#243; X&#44; Spertino J&#44; Rozas-Mu&#241;oz E&#44; Serra-Baldrich E&#44; Puig L&#46; The Effectiveness of Omalizumab Treatment in Real-Life is Lower in Patients with Chronic Urticaria Longer than 18 Months&#8217; Evolution and Prior Immunosuppressive Treatment&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;289&#8211;296&#46;</p>"
      ]
    ]
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        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IMC&#58; &#237;ndice de masa corporal&#59; UAS7&#58; puntuaci&#243;n de actividad urticarial semanal&#59; UCE&#58; urticaria cr&#243;nica espont&#225;nea&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#61; 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;SD&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#44; range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;2 &#40;16&#46;7&#44; range 16&#8211;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">BMI</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;1 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Duration of CSU &#40;months&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;1 &#40;23&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;18 Months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;47&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;24 Months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;35&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Presence of angioedema</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Previous use of corticosteroids</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>YES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;64&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Previous immunosuppressant treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>YES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;31&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Previous montelukast treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>YES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Inducible urticaria</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>YES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;35&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Baseline UAS7 &#40;mean&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;8&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Concomitant antihistaminics</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>YES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;77&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of patients&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">S12&#47;24&#58; semana 12 y 24&#59; UAS7&#58; puntuaci&#243;n de actividad urticarial semanal&#59; UCE&#58; urticaria cr&#243;nica espont&#225;nea&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="6" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical responders &#40;UAS7&#60;6&#41;</th><th class="td" title="table-head  " colspan="6" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complete responders &#40;UAS7&#61;0&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">W12</th><th class="td" title="table-head  " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">W24</th><th class="td" title="table-head  " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">W12</th><th class="td" title="table-head  " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">W24</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;0&#47;13&#46;5&#47;17&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#46;9&#47;42&#47;27&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#62;18 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Angioedema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Corticosteroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Immunosuppresant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;065&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antihistamines-H1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;065&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Results&#46;</p>"
        ]
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        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">wk&#58; week&#59; NS&#58; not stated&#59; UAS7 90&#58; &#8805;90&#37; reduction of UAS7 with respect to baseline&#59; mg&#58; milligrams&#59; CSU&#47;CindU&#58; Chronic spontaneous urticaria&#47;chronic induced urticaria</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3Randomized controlled trials&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients &#40;n&#41; &#40;CSU&#47;CIndU&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose &#40;mg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Response rate &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Response definition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Efficacy&#47; effectiveness evaluation &#40;wk&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">X-CUISITE&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;49&#47;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#8211;375&#47;2-4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">MYSTIQUE&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">90 &#40;69&#47;21&#41;</td><td class="td" title="table-entry  " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7 90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">ASTERIA I&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">318 &#40;238&#47;80&#41;</td><td class="td" title="table-entry  " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#46;9&#47;35&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#8804;6&#47; UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 and 24 &#40;not available&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">150&#47;4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#8804;6&#47; UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 and 24 &#40;not available&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">ASTERIA II&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">323 &#40;244&#47;79&#41;</td><td class="td" title="table-entry  " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;8&#47;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#8804;6&#47; UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">150&#47;4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#8804;6&#47; UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GLACIAL&#44; 2013 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">336 &#40;252&#47;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#46;4&#47;33&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#8804;6&#47; UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">X-ACT&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91 &#40;44&#47;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Michihiro et al&#46;&#44; 2017 &#40;Japan and Korea&#41;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">268 &#40;268&#47;0&#41;</td><td class="td" title="table-entry  " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ISS7 and UAS7&#8804;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">150&#47; 4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ISS7 and UAS7&#8804;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">B&#252;y&#252;k&#246;zt&#252;rk&#44; 2012 &#40;Turkey&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;12&#47;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150-300&#47;2-4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS score and QoL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 and 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Labrador-Horrillo&#44; 2013 &#40;Spain&#41;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">110 &#40;110&#47;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150-300&#47;2-4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical judgement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Armengot-Carbo et al&#46;&#44; 2013 &#40;Spain&#41;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;15&#47;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150-300&#47;2-4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical judgement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metz et al&#46;&#44; 2014 &#40;Germany&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;20&#47;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150&#8211;300 &#47;2-4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7 90 &#43; no antihistamines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Rottem et al&#46;&#44; 2014 &#40;Israel&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a></td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;13&#47;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300&#47; 4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical judgement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">30 &#40;30&#47;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150&#47; 4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical judgement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sussman et al&#46;&#44; 2014 &#40;Canada&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 &#40;61&#47;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150&#47; 4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Various&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clark et al&#46;&#44; 2016 &#40;USA&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;43&#47;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150-300&#47; 2-4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical judgement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gim&#233;nez-Arnau et al&#46;&#44; 2016 &#40;Spain&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;38&#47;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300&#47; 4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ghazanfar et al&#46;&#44; 2016 &#40;Denmark&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">154 &#40;137&#47;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150&#47;2wk-300&#47; 4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical judgement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Ensina et al&#46;&#44; 2016 &#40;Brazil&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">47 &#40;47&#47;0&#41;</td><td class="td" title="table-entry  " align="left" valign="top">150&#47; 4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical judgement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical judgement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gericke et al&#46;&#44; 2016 &#40;Germany&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;64&#47;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#8804;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wilches et al&#46;&#44; 2016 &#40;Ecuador&#41; &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;26&#47;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150&#47; 4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#8804;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kulthanan et al&#46;&#44; 2016 &#40;Thailand&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;12&#47;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150-300&#47;4wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#8804;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Various&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Present cohort &#40;Spain&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;44&#47;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300&#47;4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;8&#47;47&#46;9 &#40;wk12&#41; 64&#46;6&#47;52&#46;1 &#40;wk24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UAS7&#8804;6&#47; UAS7&#61;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 and 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Omalizumab clinical trials and real-life studies&#46;</p>"
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      "titulo" => "R&#233;f&#233;rences"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unmet clinical needs in chronic spontaneous urticaria&#46; A GA<span class="elsevierStyleSup">2</span>LEN task force report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Maurer"
                            1 => "K&#46; Weller"
                            2 => "C&#46; Bindslev-Jensen"
                            3 => "A&#46; Gim&#233;nez-Arnau"
                            4 => "P&#46;J&#46; Bousquet"
                            5 => "J&#46; Bousquet"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1398-9995.2010.02496.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergy&#46;"
                        "fecha" => "2011"
                        "volumen" => "66"
                        "paginaInicial" => "317"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21083565"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Maurer"
                            1 => "K&#46; Ros&#233;n"
                            2 => "Hsieh H-JJ"
                            3 => "S&#46; Saini"
                            4 => "C&#46; Grattan"
                            5 => "A&#46; Gimen&#233;z-Arnau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "171"
                        "paginaInicial" => "10"
                        "paginaFinal" => "13"
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Article information

ISSN: 15782190
Original language: English

DOI:10.1016/j.adengl.2018.09.015

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Year/Month	Html	Pdf	Total

2024 November	9	2	11
2024 October	70	48	118
2024 September	66	33	99
2024 August	97	61	158
2024 July	104	35	139
2024 June	75	34	109
2024 May	85	41	126
2024 April	83	20	103
2024 March	67	28	95
2024 February	68	28	96
2024 January	80	43	123
2023 December	34	16	50
2023 November	75	32	107
2023 October	52	31	83
2023 September	43	33	76
2023 August	41	14	55
2023 July	36	50	86
2023 June	39	24	63
2023 May	41	20	61
2023 April	32	18	50
2023 March	52	22	74
2023 February	48	30	78
2023 January	29	29	58
2022 December	73	39	112
2022 November	50	34	84
2022 October	27	27	54
2022 September	23	42	65
2022 August	18	41	59
2022 July	28	53	81
2022 June	42	44	86
2022 May	34	40	74
2022 April	37	38	75
2022 March	43	54	97
2022 February	37	40	77
2022 January	39	40	79
2021 December	41	47	88
2021 November	51	40	91
2021 October	54	62	116
2021 September	39	42	81
2021 August	32	35	67
2021 July	20	17	37
2021 June	30	35	65
2021 May	35	38	73
2021 April	93	70	163
2021 March	78	31	109
2021 February	82	26	108
2021 January	65	26	91
2020 December	30	27	57
2020 November	18	11	29
2020 October	21	12	33
2020 September	51	21	72
2020 August	33	25	58
2020 July	35	13	48
2020 June	33	32	65
2020 May	30	18	48
2020 April	18	17	35
2020 March	44	17	61
2020 February	1	0	1
2019 May	3	0	3
2019 April	1	0	1

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