Researchers may have identified key factors influencing the long-term effectiveness and discontinuation of omalizumab in patients with chronic urticaria, according to a multinational cohort study.

Conducted at 14 Urticaria Centers of Reference and Excellence across 10 countries, the recent study, published in JAMA Dermatology, included 2,325 patients with an average age of 42 years—71% of whom were female.

The researchers reported that omalizumab survival rates decreased from 76% at 1 year to 39% at 7 years, with a median survival time of 3.3 years. Use of omalizumab in treating chronic urticaria resulted in a 65% discontinuation rate as a result of well-controlled disease. The researchers noted that ineffectiveness and adverse effects were less common reasons for discontinuation, accounting for 18% and 4% of discontinuations, respectively.

A fast response to treatment was observed in 54% of the patients. By the end of the treatment period, 80% of the patients had a complete or good response, 12% of them had a partial response, and 8% of them did not respond.

The researchers indicated that a rapid response to omalizumab (hazard ratio [HR] = 1.45, 95% confidence interval [CI] = 1.20–1.75) and a disease duration exceeding 2 years (HR = 0.81, 95% CI = 0.67–0.98) significantly increased the likelihood of discontinuation. Additionally, immunosuppressive cotreatment at the initiation of omalizumab (HR = 1.65, 95% CI = 1.12–2.42) and existing autoimmune diseases (HR = 1.60, 95% CI = 1.08–2.36) were linked to a higher risk of discontinuation because of ineffectiveness.

The findings revealed a need to identify biomarkers to monitor chronic urticaria activity and remission, particularly among patients achieving complete control with omalizumab.

Full disclosures can be found in the original study.