Omalizumab Median Treatment Persistence Reaches 3.1 Years in Chronic Urticaria Meta-analysis

A systematic review and meta-analysis published in JAMA Dermatology evaluated long-term omalizumab treatment persistence and reasons for discontinuation in chronic urticaria. Investigators searched three databases through January 20, 2026, and included eight observational studies comprising 4,516 patients, including 3,276 with chronic spontaneous urticaria (CSU). Time-to-event data were reconstructed from published Kaplan-Meier curves, and hazard ratios were pooled using random-effects models.

Median treatment persistence was 3.1 years (95% CI, 2.8-3.4). Across a seven-year follow-up period, mean time receiving treatment was 3.75 years (95% CI, 3.62-3.87). Estimated seven-year persistence appeared higher in chronic inducible urticaria, with or without concomitant CSU, than in CSU alone: 43%-49% versus 30%. Early discontinuation was primarily attributed to well-controlled disease; discontinuation because of adverse events was uncommon.

Autoimmune comorbidity, mainly thyroid-related, was associated with greater risk of discontinuation for lack of efficacy (HR, 2.03; 95% CI, 1.20-3.41). An atopic background was associated with discontinuation after disease control. These findings may inform counseling about treatment duration, but persistence should not be equated with efficacy: stopping treatment can reflect either disease control or treatment failure. The observational evidence and reconstructed survival data limit causal interpretation; the full text was unavailable for assessment.