Omalizumab Therapy for Chronic Urticaria in the Real-Life Clinical Practice Setting : The Milanese Experience

Background: Chronic urticaria (CU) is a debilitating disease that sometimes is resistant to standard therapies. Omalizumab is a subcutaneous anti-IgE monoclonal antibody highly effective for the treatment of chronic urticaria. Our aim was to investigate the effectiveness of omalizumab and its adverse effects in a real-life clinical practice setting. Materials and methods: We conducted a retrospective analysis of the data of 77 patients treated with 300 mg/month omalizumab, we evaluated the efficacy of the treatment and retreatment calculating the weekly urticaria activity score (UAS7). Results: Seventy-seven patients received omalizumab for CU unresponsive to anti H1-antihistamines and to other medications: 54 with chronic spontaneous urticaria (CSU) alone, 3 with chronic inducible urticaria (CIndU) alone, and 20 with CSU associated with CIndU. At the end of the first month of therapy 6.7% achieved complete remission, and the complete response arose at 37.7% at the end of the first cycle of the therapy, and 42.6% never achieved complete remission but showed a marked improvement. About one half of the treated patients had a relapse after a mean of 10.6 weeks and 29 had to be re-treated. We observed few mild adverse events during the treatment with omalizumab, namely headache and arthralgya and myalgia. Conclusion: Omalizumab 300 mg was effective in difficult to treat patients with CU with rapid onset of action, it induced a long lasting positive response and maintained remission. Omalizumab was well tolerated inducing mild and sporadic side effects. Omalizumab can be the preferred third-line therapy in patients with unresponsive CU.