Follow up of Cronic spontaneous urticaria patients treated with omalizumab

Omalizumab is used for the treatment of severe spontaneous urticaria (CSU). Studies recommend the administration of 300mg every four weeks for 6 months. If the patients do not respond, guidelines recommend replacing it with cyclosporine; however, the time, doses and intervals, the treatment should be maintained is not well defined. We studied 58 patients with CSU who had a mean of UAS7 of 32.84±7.4 before 300mg of Omalizumab every 4 weeks was initiated. If they were asymptomatic, or had minimal symptoms all along two doses, the interval between them was progressively spaced by one week until an 8-week interval was reached and Omalizumab was withdrawn. If they were symptomatic, the dose was increased up to 600mg or the interval between doses was decreased. Patients received omalizumab during a mean of 31.95±19.73 months. Only 3 patients (5.1%) withdrew the treatment because of the lack of response. Twenty-three patients (39.65%) were free of symptoms after the first dose. During the whole treatment period, 31 patients (53.44%), (including 11 fast responders) required treatment adjustments, returning to the previous dose interval, or increasing doses. Fifteen patients (25.8%) finished the treatment after 38.42±19.3 months, being free of symptoms. In these, 7 needed protocol adjustments. Forty patients still continue with omalizumab at the time of the study for 30.83±19.83 months. The treatment with omalizumab in severe CSU, may last, more than 3 years. The majority of patients respond to treatment, many of them after the first dose. However doses and intervals require frequent personalized modifications.