Spacing or tapering strategies for omalizumab treatment for chronic urticaria – A real-life study

Abstract

Purpose

Omalizumab has transformed the management of chronic spontaneous urticaria refractory to H1-antihistamines, due to its high efficacy and favourable tolerability. However, discontinuation of therapy remains challenging, as no standardized recommendations exist for tapering or stopping OMZ in patients with complete response. According to the 2022 EAACI/GA²LEN/EuroGuiDerm/APAAACI guidelines, a urticaria control test score of 16 allows for “dose reduction or extension of injection intervals based on individual factors.”. The purpose of this study was to analyse different omalizumab treatment spacing strategies.

Material and methods

This was a single-centre, retrospective real-world study including patients with chronic urticaria who achieved complete remission after 4–6 months of treatment with omalizumab.

Results

Thirty-three patients (72.7 % female, mean age 51 years) were followed for a median of 5.1 years. The majority (73.3 %) attempted a gradual spacing of injections prior to discontinuation, whereas 26.7 % stopped omalizumab abruptly. The mean treatment duration was 18 ± 14.5 months. The relapse rate was 36.4 % after gradual spacing and 50 % after abrupt discontinuation, with no statistically significant difference. Following relapse (42.1 %), half of the patients resumed omalizumab. No severe adverse events were reported.

Conclusion

Although the difference was not statistically significant, these findings suggest that gradual spacing of omalizumab may reduce the risk of relapse while optimizing quality of life and costs. The observed heterogeneity in clinical practice reflects the lack of a standardized protocol. Prospective studies comparing different spacing strategies are needed to optimize long-term management of chronic spontaneous urticaria under omalizumab.