Urticaria Control Commonly Led to Omalizumab Discontinuation

Omalizumab had a median drug survival of 3.1 years among patients with chronic urticaria (CU) in a systematic review and meta-analysis published in JAMA Dermatology. Treatment discontinuation occurred more often after patients achieved good disease control than because of adverse events, the investigators reported.

The researchers evaluated how long patients continued omalizumab and factors associated with discontinuation. They searched PubMed, Embase, and Web of Science from database inception through January 20, 2026, for observational clinical studies reporting time to discontinuation or drug-survival outcomes. Time-to-event data were reconstructed from published Kaplan-Meier curves, and pooled hazard ratios were calculated with a random-effects meta-analysis.

The analysis included 8 studies and 4516 patients with CU; 3167 patients (70.1%) were female, and 3276 had chronic spontaneous urticaria (CSU). Median omalizumab drug survival was 3.1 years (95% CI, 2.8-3.4). Across 7 years of follow-up, patients received treatment for a mean of 3.75 years (95% CI, 3.62-3.87).

Long-term drug survival appeared higher among patients with chronic inducible urticaria, with or without concomitant CSU, than among those with CSU alone. At 7 years, survival ranged from 43% to 49% in the inducible-urticaria groups, compared with 30% for CSU alone. Early discontinuation was primarily attributed to well-controlled disease, while discontinuation because of adverse events was uncommon.

Autoimmune comorbidities, mainly thyroid-related, were associated with greater risk of discontinuation because of lack of efficacy (hazard ratio, 2.03; 95% CI, 1.20-3.41). An atopic background was associated with increased risk of discontinuation after disease control. The authors concluded that differing comorbidity profiles may help explain distinct discontinuation patterns. The evidence comprised 8 observational studies, and the investigators reconstructed time-to-event data from published Kaplan-Meier curves.

Source: Altayf A, Kolkhir P, Alwefati M, et al. Drug survival of omalizumab and factors associated with discontinuation in chronic urticaria: a meta-analysis. JAMA Dermatol. Published online September 9, 2026. doi:10.1001/jamadermatol.2026.2043