D2.272 - Long-Term Remission Patterns in Chronic Spontaneous Urticaria: A Real-Life Cohort Study

Chronic spontaneous urticaria (CSU) has a heterogeneous and unpredictable course. Long-term real-world data on remission rates and associated clinical factors remain limited. We aimed to evaluate long-term remission patterns and predictors in a tertiary CSU cohort.

We retrospectively analyzed 400 adult CSU patients followed between 2015 and 2024. Remission was defined as complete absence of wheals and/or angioedema for ≥12 months without treatment. Patients were categorized as remission or non-remission. Demographic, clinical, laboratory and treatment characteristics were compared. Multivariate logistic regression was performed to identify independent predictors.

Overall, 53% (n=212) achieved remission. Cumulative remission rates were 14%, 24.8%, 38.3%, 47.5%, and 53% at 1, 2, 5, 10, and 15 years, respectively. Patients controlled with antihistamines alone had higher early remission rates than those requiring omalizumab (1-year: 23.5% vs 4.5%; 2-year: 37% vs 12.5%). This difference was significant within the first two years (OR 3.48, p=0.012; OR 2.45, p=0.032) but not at later time points. Female sex (OR 2.12, p=0.014) and younger age at onset (OR 0.96 per year, p<0.001) were independently associated with remission. Longer omalizumab duration was inversely associated with remission (OR 0.63 per year, p<0.001). Among omalizumab-treated patients, baseline IgE <100 IU/mL was linked to lower remission likelihood (OR 0.5, p=0.028). Isolated pruritus after remission occurred in 14% and was associated with longer disease duration (p=0.001).

Approximately half of CSU patients achieve remission during long-term follow-up. Early remission is more frequent in patients controlled with antihistamines, likely reflecting a milder phenotype rather than treatment-driven effects. Clinical severity markers and immunologic profile may provide prognostic value and support phenotype-oriented management strategies in CSU.