Omalizumab Drug Survival in Chronic Urticaria: A Multicentric French Study

What is already known about this topic? Omalizumab is effective and well tolerated in antihistamine-resistant chronic spontaneous urticaria. Relapses after omalizumab discontinuation are frequent; however, retreatment with omalizumab is usually effective. Omalizumab discontinuation modalities differ significantly worldwide.What does this article add to our knowledge? In France, where omalizumab is fully reimbursed without a time limit, half of the patients with chronic urticaria were still treated with omalizumab 2.4 years after initiation. Patients with a longer disease duration had a longer duration of omalizumab treatment. Patients with atopic background discontinued omalizumab earlier when they achieved well-controlled disease. Patients with chronic inducible urticaria or an autoimmune background discontinued omalizumab earlier due to its ineffectiveness.How does this study impact current management guidelines? This study emphasizes the need to optimize omalizumab treatment schemes to reduce medicoeconomic costs and improve patients' quality of life. There are unmet needs for the treatment of chronic inducible urticaria; some patients, but not all, may benefit from omalizumab.BACKGROUND: Omalizumab (OMA) dramatically improves disease control and quality of life in patients with chronic urticaria (CU). OBJECTIVE: We aimed to evaluate the discontinuation patterns of OMA and their determinants in a cohort of French patients with CU. METHODS: We conducted a retrospective multicenter study in 9 French tertiary referral hospitals. All patients diagnosed with either spontaneous (CSU) and/or inducible (CIndU) CU who received at least 1 injection of OMA between 2009 and 2021 were included. We analyzed OMA drug survival and investigated possible determinants using Kaplan-Meier curves and log-rank tests.RESULTS: A total of 878 patients were included in this study; 48.8% had CSU, 10.1% CIndU, and 41.1% a combination of both. OMA was discontinued in 408 patients, but the drug was later reintroduced in 50% of them. The main reason for discontinuing treatment was the achievement of a well controlled disease in 50% of patients. Half of the patients were still being treated with OMA 2.4 years after the initiation of treatment. Drug survival was shorter in patients with CIndU and in those with an autoimmune background. In atopic patients, OMA was discontinued earlier in patients achieving a well controlled disease. A longer OMA drug survival was observed in patients with a longer disease duration at initiation.CONCLUSION: In French patients with CU, the drug survival of OMA appears to be longer than that observed in previous studies conducted elsewhere, highlighting discrepancies in prescription and reimbursement possibilities. Further studies are warranted to develop customized OMA treatment schemes based on individual patterns. (c) 2023 American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2023;11:3752-62)