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Background: Omalizumab (OMA) dramatically improves disease control and quality of life in patients with chronic urticaria (CU)., Objective: We aimed to evaluate the discontinuation patterns of OMA and their determinants in a cohort of French patients with CU., Methods: We conducted a retrospective multicenter study in 9 French tertiary referral hospitals. All patients diagnosed with either spontaneous (CSU) and/or inducible (CIndU) CU who received at least 1 injection of OMA between 2009 and 2021 were included. We analyzed OMA drug survival and investigated possible determinants using Kaplan-Meier curves and log-rank tests., Results: A total of 878 patients were included in this study; 48.8% had CSU, 10.1% CIndU, and 41.1% a combination of both. OMA was discontinued in 408 patients, but the drug was later reintroduced in 50% of them. The main reason for discontinuing treatment was the achievement of a well-controlled disease in 50% of patients. Half of the patients were still being treated with OMA 2.4 years after the initiation of treatment. Drug survival was shorter in patients with CIndU and in those with an autoimmune background. In atopic patients, OMA was discontinued earlier in patients achieving a well-controlled disease. A longer OMA drug survival was observed in patients with a longer disease duration at initiation., Conclusion: In French patients with CU, the drug survival of OMA appears to be longer than that observed in previous studies conducted elsewhere, highlighting discrepancies in prescription and reimbursement possibilities. Further studies are warranted to develop customized OMA treatment schemes based on individual patterns., (Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Résumé: La dermatite atopique (DA) et l’urticaire chronique spontanée (UCS) sont deux dermatoses inflammatoires chroniques fréquentes, qui peuvent altérer considérablement la qualité de vie. Il n’est pas rare de se trouver en situation d’échec avec les traitements dits conventionnels, à savoir les dermocorticoïdes pour la DA et les antihistaminiques de seconde génération pour l’UCS. Le recours à des traitements immunosuppresseurs peut alors être envisagé, mais leur mode d’action n’est pas spécifique de l’affection et leur utilisation non dénuée d’effets indésirables. La révolution thérapeutique que nous avons connue avec l’arrivée des biomédicaments dans le psoriasis nous incite à porter notre espoir dans le développement de thérapies davantage ciblées sur la physiopathologie de la DA et de l’UCS. [ABSTRACT FROM AUTHOR]

Purpose. – Urticaria is a muco-cutaneous illness which is characterized by a dermal or hypodermal oedema due to a vasodilatation attributed to the release of histamine by mast cells and basophils. Urticaria is a very common complaint, since among 20% of the population will experience at least one episode of urticaria during their life. Chronic urticaria by definition is daily and has persisted for at least six weeks. By contrast with acute urticaria, its etiological and therapeutic approaches can present a significant challenge, leadind to repeated examinations.Current knowledge and key points. – Questioning and clinical examination are essential for the etiological diagnosis of chronic urticaria, because they are able to lead rapidly to the suspicion of several causes which can be eradicated to treat the symptoms. If no cause is found, further investigations may be required. Recent studies have shown the lack of profitability of exhaustive laboratory investigations. Thus, many authors at present time advise minimal and non expensive investigations which are determinated by anamnestic data. But most often, the etiology of urticaria remains unknown and this situation leads to the diagnosis of chronic idiopathic urticaria. The treatment of chronic urticaria is above all based on the elimination of the symptoms, either on a specific fashion if the etiological diagnosis is already known, or in a non specific way. The anti-H1 agents are the medications of choice for first line treatment.Future prospects and projects. – Pathophysiology of chronic urticaria is to date well established. As the mechanisms responsible for chronic urticaria are better defined, more therapeutic agents, which are effective on other targets than histamine, should become available. Moreover, recent advances have supported the notion that an underlying autoimmune process could account for many cases of chronic “idiopathic” urticaria. In such severe and refractory urticaria, immunomodulation therapy may bring about clinical improvement. [Copyright &y& Elsevier]