TOPLINE:

In an observational cohort study of patients with chronic spontaneous urticaria, fast responders to omalizumab (≤ 1 month) had the longest drug survival (median, 3.9 years) and required lower maintenance doses compared to delayed and late or non-responders.

METHODOLOGY:

• Researchers analysed data of 410 adults with chronic spontaneous urticaria who initiated omalizumab treatment at Urticaria Centers of Reference and Excellence, Copenhagen, Denmark, between 2015 and 2024.
• Patients were categorised on the basis of the timing of patient-reported improvement as fast responders (≤ 1 month), delayed responders (≤ 3 months), and late or non-responders (> 3 months or no improvement).
• The analysis included treatment response timings, time to all-cause discontinuation, initiation of second treatment patterns, and dosing patterns.

TAKEAWAY:

• Overall, 49.8% of patients were fast responders, 33.7% were delayed responders, and 16.6% were late or non-responders.
• Over a median follow-up of 3.4 years, 47.8% of patients discontinued omalizumab therapy. Fast responders demonstrated the longest median time to all-cause discontinuation at 3.9 years (95% CI, 3.0-5.5), followed by delayed responders at 2.9 years (95% CI, 2.2-4.1) and late or non-responders at 1.8 years (95% CI, 1.2-2.5), with a significant trend seen across groups (hazard ratio, 1.30; P < .005).
• Re-treatment rates were highest among fast responders (29.3%) compared to those among delayed responders and late or non-responders (17.5% and 12.2%, respectively). No significant association was found between treatment duration before discontinuation and time to re-treatment among fast responders.
• Fast responders typically required median doses below 300 mg/mo, delayed responders maintained standard dosing, and late or non-responders showed progressive dose escalation, with median doses above 300 mg/mo.

IN PRACTICE:

"Patients with a fast treatment response to omalizumab generally require lower doses over time, have longer drug survival, and experience higher and faster rates of re-treatment after discontinuation compared to delayed and late/non-responders," the authors wrote, suggesting that "this study should be considered exploratory, providing a pragmatic framework to guide treatment expectations based on early treatment patterns."

SOURCE:

This study was led by Ditte Georgina Zhang, Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark. It was published online on November 12, 2025, in the Journal of the European Academy of Dermatology and Venereology.

LIMITATIONS:

This study relied on patient-reported improvement in medical records rather than validated outcome measures and did not distinguish between partial and complete responders.

DISCLOSURES:

This study did not receive any funding. Five authors reported receiving honoraria or consulting fees and having other ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.