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

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