D3.368 - Analysis of discontinuation of omalizumab in patients with chronic spontaneous and/or inducible urticaria in a tertiary hospital in one year

Omalizumab is the first drug approved for use in patients with chronic spontaneous urticaria who remain symptomatic despite treatment with antihistamines. There are studies on its withdrawal after a good response as well as cases of urticaria refractory to this treatment. 

This is a retrospective and descriptive study on the cases of omalizumab discontinuation in patients who started this treatment in 2023. 

Omalizumab was prescribed in 53 patients, 70% women, mean age of 47 years old. The diagnoses were: chronic spontaneous urticaria (CSU) 68%, chronic inducible urticaria (CindU) 15% and both 17%.

Omalizumab was discontinued in 9 of the 53 patients (17%) for the following reasons: Complete response in 3, incomplete response/no response in 3, patient decision in 1, and loss to follow-up in 2.  

The 3 patients with complete response had total IgE levels greater than 500 kU/L. The average time they were on omalizumab was 14 months. One of the 3 patients had to restart omalizumab due to recurrence of urticaria, actually with good control with omalizumab. 

The 3 discontinuations due to incomplete/no response had total IgE levels less than 50 kU/L. In these patients, a maximum dose increase of 600 mg monthly was achieved. 2 out of them are currently with dupilumab and one with cyclosporine, with currently good control.

Although omalizumab can be discontinued due to long-term remission of urticaria, there are cases of relapse episodes. There are also some cases of refractoriness.