This real-life study aimed to assess omalizumab treatment patterns in adult and pediatric asthma patients, and to describe asthma control and healthcare resource use (HCRU) at omalizumab initiation and discontinuation.The French Healthcare Database System (SNDS) was used to identify asthma patients aged ≥6 years who initiated omalizumab for at least 16 weeks from 2009 to 2019. We examined omalizumab treatment patterns using dispensation records.We identified 16 750 adults and 2453 children initiating omalizumab. Median treatment persistence before discontinuation was 51.2 [95%CI 49.3-53.4] and 53.7 [50.6-56.4] months. At two years of omalizumab exposure, rate of hospitalization for asthma decreased by 75% and use of oral corticosteroids (OCS) by 30%, in adults and children. Among adults who discontinued omalizumab while asthma was controlled, 70%, 39% and 24% remained controlled and did not resume omalizumab at 1, 2 and 3 years after discontinuation. These proportions were higher in children (76%, 44% and 33%). Over two years of follow-up after discontinuation, HCRU remained stable in adults and children, notably rate of hospitalizations for asthma (none before T(STOP), 1.3% and 0.6% at two years) and use of OCS (in adults and children, respectively: 20.0% and 20.2% before T(STOP), 33.3% and 24.6% at two years).This is the first large-scale study describing omalizumab real-life exposure patterns in adult and pediatric asthma patients in France with more than 10 years of follow-up. We showed the long-term maintenance of low HCRU in adults and children who discontinued omalizumab while asthma was controlled, notably for OCS use and hospitalizations for asthma.Read less <