Patients with chronic urticaria who stop omalizumab often do so after treatment success

Key takeaways:

• Omalizumab survival rates decreased from 76% after 1 year to 39% after 7 years.
• The main reasons for discontinuation were well-controlled disease (65%), ineffectiveness (18%) and adverse events (4%).

Omalizumab is effective and safe for the treatment of chronic urticaria, demonstrating high discontinuation due to well-controlled disease, according to a study.

“Chronic urticaria is characterized by recurrent, severely itching wheals, angioedema, or both, for longer than 6 weeks,” Reineke Soegiharto, MD, a PhD candidate in the department of dermatology at the University Medical Center Ultrecht, and colleagues wrote. “Currently, little is known about the long-term performance of omalizumab in daily practice regarding the lengths of treatment duration and reasons and potential predictors for treatment discontinuation.”

To learn more, the authors analyzed omalizumab drug survival as well as the reasons and potential predictors for discontinuation in patients being treated with the drug for chronic urticaria.

Data on 2,325 patients (mean age, 42 years; 71% women) were retrieved from 14 Urticaria Centers of Reference and Excellence in 10 countries.

Results showed that omalizumab survival rates decreased from 76% after 1 year to 39% after 7 years, making the median survival time 3.3 years (95% CI, 2.9-4).

Patients primarily discontinued omalizumab due to disease control (65%), whereas others did so due to ineffectiveness (18%), adverse events (4%), a combination of the previous reasons (2%) planning for pregnancy (5%) and other or unknown (10%).

According to the study, higher rates of omalizumab discontinuation were associated with fast treatment responses (HR = 1.45; 95% CI, 1.2-1.75). On the other hand, lower rates of discontinuation were associated with urticaria present for more than 2 years (HR = 0.81; 95% CI, 0.67-0.98) and the presence of chronic inducible urticaria (HR = 0.65; 95% CI, 0.54-0.8).

Potential predictors of discontinuation due to ineffectiveness were highly associated with immunosuppressive cotreatment at the initiation of omalizumab (HR = 1.65; 95% CI, 1.12-2.42) and concomitant autoimmune disease (HR = 1.6; 95% CI, 1.08-2.36), whereas a lower chance of discontinuation was associated with the presence of spontaneous wheals (HR = 0.62; 95% CI, 0.41-0.93) and access to higher dosages (HR = 0.4; 95% CI, 0.27-0.58).

“The high performance of omalizumab in daily practice is confirmed by demonstrating that most patients were able to discontinue omalizumab due to well-controlled disease,” the authors concluded.