Factors Influencing Relapse After Omalizumab in Chronic Urticaria. Does the Method of Discontinuation Influence Relapse?

Introduction: Omalizumab is recommended for chronic urticaria (CU) until spontaneous remission occurs rather than for a specific period of time. The rate of relapse after treatment varies depending on the method of discontinuation.

Objectives: Our study aimed to investigate how the method of omalizumab discontinuation and other factors affect the rate of post-treatment relapses.

Methods: Patients with CU were divided into three groups based on their method of discontinuing omalizumab treatment: direct discontinuation, extending treatment intervals to eight weeks, and reducing the treatment dose to 150 mg/4 weeks. These groups were then compared for relapse rates.

Results: A total of 200 patients were included in this study. Among the 109 patients who discontinued omalizumab directly, 65.1% experienced a relapse. The relapse rate was 40.7% in those who extended the treatment intervals to eight weeks and 15.6% in those who reduced the dose to 150 mg/4 weeks. There was a statistically significant difference in post-treatment relapse rates according to the method of discontinuation (P< 0.001).

Conclusions: Gradual tapering of treatment rather than direct discontinuation has been shown to prolong remission. Achieving the lowest relapse rate with a reduction in the treatment dose to 150 mg/4 weeks is significant for the design of omalizumab discontinuation protocol and provides insights for future studies.