key: cord-1021812-2tyuwpq6 authors: King, Catherine; Cox, Fionnuala; Sloan, Anne; McCrea, Patricia; Edgar, J David; Conlon, Niall title: Rapid transition to home omalizumab treatment for chronic spontaneous urticaria during the COVID-19 pandemic: a patient perspective. date: 2021-09-21 journal: World Allergy Organ J DOI: 10.1016/j.waojou.2021.100587 sha: bc18a948c3fd568fa6e32261d965b49889c6c9cb doc_id: 1021812 cord_uid: 2tyuwpq6 Efforts to reduce non-urgent hospital attendances during the COVID-19 pandemic have been the focus of much attention by healthcare professionals worldwide. In Ireland due to funding constraints omalizumab has only been available for hospital-based administration. Fifty-eight patients with chronic spontaneous urticaria and angioedema (CSU) receiving omalizumab in our centre were rapidly transitioned to home self-administration at the start of the pandemic. We conducted an anonymised patient survey after three months of home therapy with the aim of characterizing the patient experience throughout this period. 41 patients participated in our questionnaire (71% response rate). 93% of patients favoured self-injection of Omalizumab from home, with respondents citing cost savings, time savings, improved flexibility, fewer hospital visits and less risk of exposure to COVID-19 infection as particular benefits. Concerns regarding home administration including injecting incorrectly, forgetting a dose or having a reaction were reported very infrequently. 83% of patients wished to continue with home therapy long-term. This survey highlights broadly positive experiences for patients rapidly transitioning to home omalizumab administration. This data will be useful to inform healthcare funders in decisions regarding patient-centred care in CSU. Facilitating home omalizumab therapy in suitable CSU patients should be strongly considered in the post-pandemic setting. Main Text The disruption of healthcare services due to COVID-19 has led to innovations in service delivery that 26 may have implications for patient care beyond the pandemic. Patients with chronic spontaneous 27 urticaria and angioedema (CSU) have been affected, with a recent international study reporting 28 significant decreases in face-to-face clinical encounters, reduced prescribing of immunosuppressive 29 therapies, and associated flares of CSU in the setting of concurrent COVID-19 infection [1] . CSU patients with symptoms refractory to high dose antihistamines may benefit from the anti-IgE 32 monoclonal antibody omalizumab [2] . In Ireland, this medication has been solely available as a 33 hospital-based treatment, despite licensing approval for self-administration having been granted in 34 2018 [3] . Given the exceptional circumstances of the COVID-19 pandemic and the need to limit Respondents indicated on a rating scale how likely they would be to recommend home-based 87 omalizumab to others with their condition (0 = definitely would not recommend, 10 = definitely 88 would recommend), with an average rating of 8.88 given. They were also asked to rate their overall 6 A frequently cited barrier to home-based omalizumab administration has been the reported risk of 116 anaphylaxis (estimated at 0.2% [5] ), however, this was not reported in the key clinical trials investigating the use of omalizumab in CSU [6, 7] . Individual centres have reported success in 118 transitioning patients with CSU from hospital-to home-based omalizumab administration, with 119 similar experiences reflected in a recent multicentre report of 137 patients, where no increase in 120 adverse events or episodes of anaphylaxis were observed [8, 9] . No studies have specifically focused on 121 the patient experience in this setting however. Our situation was unique. Given the unanticipated 122 circumstances of the pandemic, we were not afforded months of planning prior to implementing this 123 transition. Our data indicates that the strong support for home-based treatment amongst this cohort is not solely 165 solution-for-injection-34262/spc. Accessed 12 th Omalizumab for combination therapy Home Self-Administration of 188 Omalizumab for Chronic Spontaneous Urticaria Multicentre experience of home 190 Omalizumab treatment for chronic spontaneous urticaria Association among stress, hypocortisolism, systemic inflammation, and disease severity in 194 chronic urticaria Replacement IgG therapy and self-therapy at home improve the 196 health-related quality of life in patients with primary antibody deficiencies Self-administration of subcutaneous depot medroxyprogesterone 199 acetate for contraception: feasibility and acceptability Treatment Mode 201 Preferences in Rheumatoid Arthritis: Moving Toward Shared Decision-Making Patient preferences and satisfaction in the treatment of rheumatoid arthritis with 204 biologic therapy Angioedema and prescribing of omalizumab 206 for chronic urticaria in countries with limited financial resources