Omalizumab Is Equally Effective in Persistent Allergic Oral Corticosteroid-Dependent Asthma Caused by Either Seasonal or Perennial Allergens: A Pilot Study

Abstract

Omalizumab is marketed for chronic severe asthma patients who are allergic to perennial allergens. Our purpose was to investigate whether omalizumab is also effective in persistent severe asthma due to seasonal allergens. Thirty patients with oral corticosteroid-dependent asthma were treated with Omalizumab according to the dosing table. For each patient with asthma due to seasonal allergens, we recruited the next two consecutive patients with asthma due to perennial allergens. The dose of oral methyl prednisolone (MP) was tapered at a rate of 2 mg every two weeks after the start of treatment with omalizumab depending on tolerance. At each monthly visit, a forced spirometry and fractional exhaled nitric oxide (FeNO) measurement were performed and the accumulated monthly MP dose was calculated. At entry, there were no differences between groups in terms of gender, body mass index or obesity, year exacerbation rate, monthly dose of MP, FeNO and blood immunoglobuline E (IgE) values, or spirometry (perennial: FVC: 76%; FEV1: 62%; seasonal: FVC: 79%; FEV1: 70%). The follow-up lasted 76 weeks. One patient in each group was considered a non-responder. Spirometry did not worsen in either group. There was a significant intragroup reduction in annual exacerbation rate and MP consumption but no differences were detected in the intergroup comparison. Omalizumab offered the same clinical benefits in the two cohorts regardless of whether the asthma was caused by a seasonal or a perennial allergen. These results strongly suggest that allergens are the trigger in chronic asthma but that it is the persistent exposure to IgE that causes the chronicity.

Economic Impact and Clinical Outcomes of Omalizumab Add-On Therapy for Patients with Severe Persistent Asthma: A Real-World Study

“…Benefits of omalizumab may extend up to 2–4 years, and the majority of omalizumab-treated patients may benefit for many years in terms of clinical, quality of life and health resource utilization outcomes [41]. Interestingly, a recent study showed that omalizumab offers the same clinical benefit in patients with persistent allergic asthma regardless of whether the asthma was caused by seasonal or perennial allergens [42].…”

Chronic rhinosinusitis and omalizumab: eosinophils not IgE predict treatment response in real-life

“…to having a count of <150 cells/ µL ( Figure 1B). to either pollens or perennial allergens (23) . Omalizumab efficacy in non-allergic asthma, urticaria and eosinophilic oesophagitis further emphasises its ability to modulate complex immune cascades in so called 'non-allergic states' (24)(25)(26)(27) .…”

A step‐down protocol for omalizumab treatment in oral corticosteroid‐dependent allergic asthma patients

“…Omalizumab (OMA) (Xolair Novartis ® ), a murine immunoglobulin E (IgE) monoclonal antibody (mAb) blocking agent marketed since late 2006 , is currently recommended for unstable allergic GINA step IV and GINA step V asthma patients, before the administration of oral corticosteroids (OC) . Encouraging results with off‐label prescriptions of OMA have also been reported. OMA initially showed a sparing effect of inhaled corticoids , and two recent studies have also shown its oral corticosteroid‐sparing effect in severe allergic asthma patients .…”