Clinical, immunologic, and treatment burden of nonsteroidal anti-inflammatory drug-exacerbated cutaneous disease

Nonsteroidal anti-inflammatory drugs (NSAIDs) are major exacerbating factors in approximately one-third of patients with chronic spontaneous urticaria (CSU), contributing to disease chronicity and severity. However, comprehensive comparisons of clinical characteristics and treatment responses remain limited.

To analyze baseline characteristics, immunologic parameters, and treatment outcomes in patients with NSAID-exacerbated chronic disease (NECD) compared with those with NSAID-tolerant chronic urticaria (NTCU), using long-term outcome models in a large, real-world clinical cohort.

From a cohort of 9632 adult patients with CSU, 966 patients with NECD were identified by diagnostic codes and were analyzed against the remaining patients with NTCU. Clinical and laboratory findings, medication requirements, and long-term clinical outcomes were compared between the 2 groups.

The disease duration was significantly longer in patients with NECD (42.7 ± 46.3 vs 21.9 ± 30.9 months, P < .001), and the prevalence of angioedema was higher (58.1% vs 23.4%, P < .001). They required longer treatment durations with antihistamines and leukotriene receptor antagonists (P < .001 for all). The daily dose of systemic corticosteroids was also higher (11.7 ± 6.1 vs 10.4 ± 6.9 mg, P < .001). Patients with NECD also had longer omalizumab treatment durations, with no difference in cyclosporine use.

Our findings confirm that NECD represents a more chronic and treatment-resistant phenotype within patients with CSU. These results provide valuable insights into the distinct clinical and immunologic profiles of NECD, underscoring its higher disease burden and refractory nature.