Omalizumab treatment for allergic bronchopulmonary aspergillosis in young patients with cystic fibrosis

• Published in: Respiratory medicine Vol. 133; no. 2; pp. 12 - 15
• Main Authors: Perisson, Caroline, Destruys, Leila, Grenet, Dominique, Bassinet, Laurence, Derelle, Jocelyne, Sermet-Gaudelus, Isabelle, Thumerelle, Caroline, Prevotat, Anne, Rosner, Vincent, Clement, Annick, Corvol, Harriet
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2017; Elsevier Limited; Elsevier
• Subjects: Adolescent; Adrenal Cortex Hormones - therapeutic use; Allergens; Allergic bronchopulmonary aspergillosis; Allergies; Anti-Allergic Agents - therapeutic use; Antibodies, Anti-Idiotypic - therapeutic use; Antifungal Agents - therapeutic use; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary - complications; Aspergillosis, Allergic Bronchopulmonary - drug therapy; Aspergillosis, Allergic Bronchopulmonary - physiopathology; Aspergillus fumigatus - drug effects; Asthma; Biological effects; Body mass index; Child; Clinical trials; Corticoids; Corticosteroids; Cystic fibrosis; Cystic Fibrosis - complications; Cystic Fibrosis - drug therapy; Cystic Fibrosis - immunology; Data collection; Diabetes; Female; Fungal infections; Human health and pathology; Humans; Hypersensitivity; Immunoglobulin E; Immunotherapy; Life Sciences; Lung diseases; Lung function; Male; Monoclonal antibodies; Mutation; Nutritional status; Omalizumab; Omalizumab - administration & dosage; Omalizumab - therapeutic use; Patients; Pulmonology and respiratory tract; Respiratory function; Respiratory Function Tests - methods; Retrospective Studies; Side effects; Systematic review; Young Adult; Omalizumab; Cystic fibrosis; Lung function; Allergic bronchopulmonary aspergillosis
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2017.11.007

Allergic bronchopulmonary aspergillosis (ABPA) is a severe lung disease complication caused by an Aspergillus fumigatus-induced hypersensitivity that affects 2–15% of patients with cystic fibrosis (CF). The mainstay treatment consists of a combination of corticosteroids and antifungals. However, repeated or long-term corticosteroid therapies can lead to serious side effects. The monoclonal anti-IgE antibody, omalizumab, has demonstrated its efficacy in allergic asthma. As ABPA results from a hypersensitivity to a specific allergen, omalizumab might benefit CF patients with ABPA. Therefore, we conducted a retrospective study to investigate the effects of omalizumab on ABPA in CF patients.
We retrospectively analyzed the clinical records of young patients with CF treated with omalizumab for an ABPA in several French CF centers. The clinical data were collected 3 months before the start of omalizumab treatment, at initiation, and every 3 months up to 12 following initiation. These data comprised clinical, biological, nutritional, and functional parameters.
Eighteen patients were included (mean age: 17.1 ± 5.2 yrs). Under omalizumab was observed a stabilization of the lung function decline associated with a significant decrease in the corticosteroid daily dose (p = 0.0007) and an improvement in the nutritional status (p = 0.01). No serious side effect of omalizumab was reported.
This study suggests that omalizumab might be an interesting therapeutic strategy in ABPA, associated with less side effects compared to long-term corticosteroids. Further randomized-controlled trials are needed to ascertain the efficacy of omalizumab in CF patients with ABPA.
•ABPA affects 2–15% of patients with CF.•Corticosteroids are the main treatment but can lead to serious side effects.•We showed that omalizumab could be an interesting therapeutic strategy.•This therapy was indeed associated with a dramatic steroid sparing effect.