Chronic urticaria patients are interested in apps to monitor their disease activity and control: A UCARE CURICT analysis

Abstract Background Information/communication technologies such as mobile phone applications (apps) would enable chronic urticaria (CU) patients to self‐evaluate their disease activity and control. Yet, recently Antó et al (2021) reported a global paucity of such apps for patients with CU. In this analysis, we assessed patient interest in using apps to monitor CU disease activity and control using questions from the chronic urticaria information and communication technologies (CURICT) study. Methods The methodology for CURICT has been reported. Briefly, a 23‐item questionnaire was completed by 1841 CU patients from 17 UCAREs across 17 countries. Here, we analyzed patient responses to the CURICT questions on the use of apps for urticaria‐related purposes. Results As previously published, the majority of respondents had chronic spontaneous urticaria (CSU; 63%; 18% chronic inducible urticaria (CIndU) [CIndu]; 19% with both), were female (70%) and in urban areas (75%). Over half of patients were very/extremely interested in an app to monitor disease activity (51%) and control (53%), while only ∼1/10 were not. Patients with both urticaria types versus those with CSU only (odds ratio [OR], 1.36 [1.03–1.79]) and females versus males (OR [95% CI], 1.47 [1.17–1.85]) were more likely to be very to extremely interested in an app to assess disease control. Conclusions Overall, half of the patients with CU were very to extremely interested in using an app to assess their disease activity and control. Development of well‐designed apps, specific to disease types (CSU, CIndU, CSU + CIndU, etc), validated by experts across platforms would help improve the management and possibly outcomes of CU treatment while providing important patient information to be used in future research.


| INTRODUCTION
In the recent Urticaria Centers of Reference and Excellence (UCARE) study, chronic urticaria information and communication technologies (CURICT), we assessed use and interest in information and communications technologies (ICTs) for patients with chronic urticaria (CU). 1,2 We found that almost all CU patients had access to ICTs and most were using these regularly to obtain health and disease-related information. 1 Specifically, most patients with CU were interested in ICTs to receive disease information and to communicate with their physicians and other patients about their urticaria. 2 Information and communications technologies such as mobile phone applications (apps) would enable patients to (i) self-evaluate their disease activity, impact, and control, (ii) improve selfmanagement and (iii) optimize their therapy including allergic comorbidities. Yet, very recently, Antó et al (2021) reported a global paucity of such apps for patients with CU. 3 To date, the unmet need for suitable apps from the patient's point of view remains unknown.

| Objective
Using questions from the CURICT study, we assessed patient interest in using apps to monitor CU disease activity and control.

| Study design and population
The scope, methodology, conduct, and other results of the CURICT study have been previously reported. 1

| Statistical analysis
The agreement scale was dichotomized as "agree-to-strongly agree" (agree and strongly agree) and "not agree-to-strongly agree" (strongly disagree, disagree and undecided). Similarly, the interest scale was dichotomized as "very-to-extremely interested" (very interested and extremely interested) and "not very-to-extremely interested" (not interested, slightly interested and moderately interested).
A binomial logistic regression analysis was performed to predict the likelihood of being very to extremely interested or not in app development described above given the effects of age, gender, educational level, region, living area, economy according to the World Bank data, urticaria type and years with diagnosis.
All data were analyzed using SPSS version 24.0 software (SPSS Inc.).

| Ethical considerations
This study was approved by the ethics committee "Comité de ética e Investigación en Seres Humanos" (CEISH), Guayaquil, Ecuador (IRB number HCK-CEISH-19-0059) and by a committee for each participating UCARE center. Each participant provided consent to completion of the anonymous survey, and confidentiality was maintained throughout the study.

| More than half of patients with CU are very to extremely interested in an app to monitor disease activity and control
Over half of patients were very or extremely interested in the development of an app to monitor disease activity (51%; n = 946) and control (53%; n = 967), while only ∼1/10 were not interested at all in apps to assess such parameters (urticaria activity, 12.8%, n = 236; urticaria control, 12.0%, n = 221).

| Comorbid CIndU in patients with CSU is linked to higher levels of interest in the use of an app to assess disease control
Patients with both urticaria types reported a greater likelihood of being very to extremely interested in app development to assess CHERREZ-OJEDA ET AL.

| Female patients and those with higher education are significantly more likely to use apps for disease control
Female patients were more likely than males to be very/extremely interested in the development of an app to monitor disease control (  Our study included a large sample of patients and utilized a network of researchers across the world. However, the study design was cross-sectional and therefore cause-and-effect relationships could not be detected; in addition, while the questionnaire was developed by experts worldwide, it has not been confirmed in validation studies to date. Also, we did not record the disease severity and control, and as such, we cannot identify if these variables could affect the outcomes of interest.

| CONCLUSIONS
Overall, over half of patients with CU were very to extremely interested in using an app to assess their disease activity and control.
Development of well-designed apps, specific to disease types (CSU, CIndU, CSU + CIndU, etc), validated by experts across platforms would help improve the management and possibly outcomes of CU treatment while providing important patient information to be used in future research.

ACKNOWLEDGMENTS
The authors would like to thank all of the study participants as well as Leonard Lionnet, PhD for providing medical writing assistance.
This study was funded by the network of urticaria centers of reference and excellence (UCARE, www.ga2len-ucare.com).