Résumé
Chronic urticaria (CU) affects about 1% of the population and impacts quality of life. Since 2018, omalizumab is recommended as third-line therapy in CSU when up-dosed antihistamines are poorly tolerated or inefficient. We aimed to describe the real-life use and discontinuation modalities of omalizumab in chronic urticaria referral centres since its commercialization in this indication. Methods: we performed a retrospective, multicentric, observational French study including patients with chronic spontaneous (CSU) and/or inducible (CIndU) urticaria, treated with omalizumab at least once between 2005 and 2020. Drug survival analyses were performed, and determinants of drug survival were analysed. Results: 878 patients were included with 82.8% CSU or predominant CSU and 10.1% CIndU. Complete response (CR) was obtained in 75.6%. CR was lower in CIndU. 66% patients were still receiving omalizumab at 1 year and 30.9% at 6 years. Main reason to discontinuation was wellcontrolled disease. Shorter drug-survival was noted in patients with CIndU, autoimmunity and previous treatment by immunomodulators. Longer drug-survival was associated with longer disease duration. Atopic patients were more likely to stop omalizumab sooner for well-controlled disease. 48% of patients who discontinued omalizumab were further retreated with >70% similar efficacy in CSU and in CIndU patients. Many practicians chose to lengthen dose interval during follow-up. Conclusion: in view of good efficacy at retreatment, drug cost and high natural remission rates in chronic urticaria, trying to discontinue omalizumab appears reasonable. Further studies are needed to identify predictive factors of relapse as well as strategies to minimize them.