What Drives Patient Acceptance of Advanced Therapies in Chronic Urticaria?

New research is shedding light on why many patients with chronic spontaneous urticaria (CSU) remain hesitant to adopt advanced treatments, even as newer biologic and targeted therapies show promise in managing the condition.¹

Despite existing treatments such as antihistamines, many patients with CSU continue to experience persistent symptoms, prompting the development of newer therapies, including biologics and small molecule targeted drugs (SMTD), such as omalizumab (Xolair; Novartis) and remibrutinib (Rhapsido; Novartis).^2-3 While these treatments have demonstrated clinical benefits, their real-world adoption has been inconsistent.

A recent cross-sectional study conducted in China offers new insight into the factors influencing patient willingness to use these therapies, highlighting the critical role of education, perception, and awareness in treatment decision-making. The findings were published in Patient Preference and Adherence.¹

The study surveyed 711 adult patients with CSU at a dermatology clinic in Shanghai between 2024 and 2025. Researchers found that just over half of participants (53%) were aware of biologics and targeted therapies, and fewer than half (approximately 48%) expressed willingness to use them.

Among the most influential factors driving acceptance were patients’ perceptions of treatment effectiveness and safety. Those who believed these therapies were effective were far more likely to consider using them, with perceived efficacy emerging as the strongest predictor of acceptance. Similarly, patients who felt confident in the safety of these treatments were significantly more open to adoption.

“Enhancing awareness and addressing concerns regarding safety and expected benefits may facilitate more informed and confident decision-making, ultimately supporting the broader integration of biologics and SMTD into CSU management in China,” detailed the researchers.

Demographic and lifestyle factors also played a role. Patients with higher levels of education (OR, 5.44; 95% CI, 1.09-27.08) were significantly more likely to accept biologics and targeted treatments, suggesting that health literacy may influence openness to newer medical options. Married patients (OR, 3.79; 95% CI, 1.29-11.17) and those with a family history of CSU (OR, 5.97; 95% CI, 2.75-12.95) were also more likely to express willingness to try these therapies.

Conversely, alcohol consumption was associated with lower acceptance rates (OR, 0.37; 95% CI, 0.15-0.88), though the reasons for this relationship remain unclear. Researchers suggested that lifestyle factors may influence perceptions of health risks or treatment priorities.

“These associations underscore the influence of sociodemographic factors in shaping treatment preferences and suggest that clinicians may consider more actively recommending these emerging therapies to patients who exhibit such characteristics, as they may be more receptive to novel treatment options,” wrote the researchers.

Interestingly, while many patients reported receiving recommendations from dermatologists, physician guidance alone did not independently predict whether patients would accept treatment once other factors were considered (OR, 1.51; 95% CI, 0.73–3.09). This suggests, explained the researchers, that clinical recommendations may influence patient awareness and understanding indirectly, rather than serving as a decisive factor on their own.

The study also pointed to broader cultural influences that may shape treatment decisions. In China, patients may take a more cautious approach to newer therapies, prioritizing long-term safety and familiarity with established treatments. This cultural context, combined with varying levels of awareness, may contribute to slower adoption of innovative options.

The researchers argued that improving patient education could be key to bridging this gap. Clear, evidence-based communication about how biologics and targeted therapies work and what patients can realistically expect in terms of safety and effectiveness may help build confidence and support more informed decision-making.

Despite its insights, the study had limitations. As a single-center, cross-sectional analysis, it cannot establish cause-and-effect relationships, and its findings may not fully reflect broader patient populations. Additionally, reliance on self-reported data introduces the possibility of bias.

References:

1. Yang Y, Gao C, Fei X, Wang RR, Jiang W. Factors influencing acceptance of biologics and small molecule targeted drugs among patients with chronic spontaneous urticaria: a cross-sectional study. Patient Prefer Adherence. 2026;20:558796. doi:10.2147/PPA.S558796

2. Novartis announces FDA approval of Xolair (omalizumab) for chronic idiopathic urticaria (CIU), a form of chronic hives. Novartis. Published online March 21, 2014. Accessed March 26, 2026. https://www.novartis.com/us-en/news/media-releases/novartis-announces-fda-approval-xolair-omalizumab-chronic-idiopathic-urticaria-ciu-form-chronic-hives

3. Novartis receives FDA approval for Rhapsido (remibrutinib), the only oral, targeted BTKi treatment for chronic spontaneous urticaria (CSU). Novartis. Published online September 20, 2025. https://www.novartis.com/us-en/news/media-releases/novartis-receives-fda-approval-rhapsido-remibrutinib-only-oral-targeted-btki-treatment-chronic-spontaneous-urticaria-csu