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Omalizumab in the management of oral corticosteroid-dependent IGE-mediated asthma patients.
MedLine Citation:
PMID:  21083517     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Several studies have demonstrated the beneficial effects of omalizumab in asthma patients. Here we describe the drug's tolerance and oral corticosteroid sparing capacity in a long-term observational study.
METHODS: Thirty-two patients aged ≥18 years with obstructive airway disease and FEV(1) reversibility ≥12% and 200  mL, with an oral steroid requirement ≥7.5  mg per day of prednisolone during a period of ≥1 year, a positive prick test or in vitro reactivity (RAST) to at least one perennial aeroallergen and a baseline immunoglobulin E level ranking between 30-700  IU/mL were prospectively followed for 17.2  ±  8.5 months. Patients were visited once or twice a month, depending on their schedule for omalizumab administration.
INTERVENTION: blood analysis every six months; spirometry and nitric oxide measurement at every visit.
RESULTS: One patient who dropped out early was excluded. Follow-up period: the treatment benefited 83.9% (26/31) of the cohort; oral corticosteroids were reduced from 7.19 ± 11.1 to 3.29 ± 11.03  mg (p < 0.002) and withdrawn in 74.2% of patients. FEV(1) (percent predicted) was 64.4 ± 22.7 at the beginning and 62.9 ± 24.3 at the end. IgE at entry was 322.2 ± 334.2  IU/mL and increased 2.34-fold. Respiratory function and NO did not present statistically significant changes. We identified three groups of patients: the first (n = 17) receiving oral steroid at entry in whom the accumulated dose of oral steroids progressively decreased; another (n = 10) including patients who had quit oral steroids before starting omalizumab although they had not been instructed to do so and whose oral steroid dose at the end of follow-up was zero; and a third group (n = 4) that did not benefit from omalizumab treatment. The only relevant side effect was a flu-like syndrome which required discontinuation of treatment in one patient.
CONCLUSION: In our series, a substantial, safe decrease in oral corticosteroid requirements was observed due, at least to some extent, to omalizumab therapy. Oral corticosteroids were withdrawn in three-quarters of the patients. We were unable to identify a factor able to predict which patients would benefit most from omalizumab treatment.
Authors:
Christian Domingo; Amalia Moreno; Ma José Amengual; Concepción Montón; David Suárez; Xavier Pomares
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-11-18
Journal Detail:
Title:  Current medical research and opinion     Volume:  27     ISSN:  1473-4877     ISO Abbreviation:  Curr Med Res Opin     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0351014     Medline TA:  Curr Med Res Opin     Country:  England    
Other Details:
Languages:  eng     Pagination:  45-53     Citation Subset:  IM    
Affiliation:
Pneumology Service, Corporació Parc Taulí, Sabadell, Spain. cdomingo@tauli.cat
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