A big question since Xolair was approved for chronic idiopathic urticaria last year, http://allergylosangeles.com/allergy-blog/xolair-omalizumab-for-chronic-urticaria/
is what should be the Xolair treatment duration for these patients? There have been few studies that have evaluated patients being treated for hives with Xolair for greater than 1 year, since it only has been recently approved.
Chronic hives is a disease where urticarial lesions recur or last longer than 6 weeks. First line therapy for patients are typically non-sedating second generation antihistamines up to 4 times the standard dosages.
Recent practice parameters recommend for patients those inadequately treated with these medications to use Xolair or omalizumab. Other alternative therapies are oral steroids, cyclopsporine, dapsone, sulfasalazine, hydroxychloroquinine, cholchicine, tacrolimus an mycophenolate. Many of these medications have severe systemic side effects, thus limiting their long term usage. Because Xolair was only recently approved, the Xolair treatment duration for chronic hives is unknown. It is also a very expensive medication and the long term usage can be quite burdensome.
A recent study was done of 17 patients started on a trial of Xolair for chronic hives. 10 patients responded and 7 did not. Therefore, 10 patients (5 male and 5 female) were included in the study. 8 of the 10 patients had complete resolution of the hives and they took the Xolair for an average of 3 years. The recommended dosage for chronic hives is 150mg or 300mg every 4 weeks. Most patients were able to tolerate longer treatment durations even up to 10 weeks, but most patients did have a recurrence of hives when the Xolair was completely stopped.
So although Xolair for chronic hives is recommended every 4 weeks, many patients are able to tolerate longer treatment intervals, anywhere from 6 to 10 weeks. Periodic attempts to weaning patients off Xolair should be attempted because there is a chance of spontaneous remission. However, this could be difficult because symptoms are likely to recur, but at least the time interval between shots can be lengthened.
If you have chronic idiopathic urticaria or chronic hives and are being treated with Xolair, you should speak to your allergist or allergy doctor about the interval of your Xolair shots and what the Xolair treatment duration should be. Xolair (omalizumab) has a good long-term safety profile. All patients need to have their treatment tailored to them and everyone responds differently. As you can see, some patients do not respond at all to Xolair and to those that do, the interval of injections can be widely different.
Not everyone responds to Xolair, here in this article, we examine what percentage of patient do respond. http://allergylosangeles.com/allergy-blog/response-of-hives-after-treatment-with-xolair/