OMALIZUMAB drug survival was 3.1 years in patients with chronic urticaria (CU), with discontinuation more often associated with disease control than adverse events, according to a systematic review and meta-analysis of eight observational studies.
The analysis included 4516 patients with CU, of whom 3167 (70.1%) were female and 3276 had chronic spontaneous urticaria (CSU). The researchers reconstructed time-to-event data from published Kaplan-Meier curves and pooled hazard ratios (HRs) using a random-effects meta-analysis.
Over seven years of follow-up, patients continued omalizumab treatment for a mean of 3.75 years (95% confidence interval [CI]: 3.62–3.87), while median drug survival was 3.1 years (95% CI: 2.8–3.4).
Early discontinuation of omalizumab was primarily associated with well-controlled disease, while discontinuation due to adverse events was uncommon.
Long-term drug survival appeared higher among patients with chronic inducible urticaria, with or without concomitant CSU, than among those with CSU alone. Seven-year survival ranged from 43–49% in patients with chronic inducible urticaria compared with 30% in those with CSU alone.
The findings also indicated distinct associations between comorbidity profiles and reasons for discontinuation. Autoimmune comorbidity was associated with an increased risk of discontinuation due to lack of efficacy (HR: 2.03; 95% CI: 1.20–3.41).
An atopic background was associated with an increased risk of discontinuation following disease control, contrasting with the association between autoimmune comorbidity and discontinuation due to lack of efficacy.
The researchers concluded that omalizumab demonstrated long-term drug survival in CU, with treatment more frequently discontinued following disease control than because of adverse events. Autoimmune comorbidities, particularly thyroid-related conditions, were associated with reduced drug survival primarily because of lack of efficacy.
The findings suggested that identifying distinct clinical endotypes may help inform longer-term treatment strategies and patient stratification. However, the analysis was based on observational clinical studies, and the reported associations do not establish causation.
Reference
Altayf A et al. Drug survival of omalizumab and factors associated with discontinuation in chronic urticaria: a meta-analysis. JAMA Dermatol. 2026;DOI: 10.1001/jamadermatol.2026.2043.
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