Efficacy and safety of a recombinant anti-immunoglobulin E antibody (omalizumab) in severe allergic asthma

• Published in: Clinical and experimental allergy Vol. 34; no. 4; pp. 632 - 638
• Main Authors: Holgate, S. T., Chuchalin, A. G., Hébert, J., Lötvall, J., Persson, G. B., Chung, K. F., Bousquet, J., Kerstjens, H. A., Fox, H., Thirlwell, J., Cioppa, G. Della
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-04-2004; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Aged; allergic asthma; Androstadienes - administration & dosage; Anti-Asthmatic Agents - adverse effects; Anti-Asthmatic Agents - therapeutic use; Antibodies, Anti-Idiotypic - adverse effects; Antibodies, Anti-Idiotypic - therapeutic use; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; ASTHMA; Asthma - drug therapy; Bronchodilator Agents - administration & dosage; Child; CHILDHOOD; Clinical Medicine; COMPLEX-FORMATION; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluticasone; Humans; IgE; IGE MONOCLONAL-ANTIBODY; Immunoglobulin E - immunology; Klinisk medicin; Lungmedicin och allergi; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; monoclonal antibody; Omalizumab; POLLEN; QUALITY-OF-LIFE; Respiratory Medicine and Allergy; RHINITIS; Treatment Outcome
• ISSN: 0954-7894; 1365-2222; 1365-2222
• DOI: 10.1111/j.1365-2222.2004.1916.x

Summary
Background
Patients with severe asthma are often inadequately controlled on existing anti‐asthma therapy, constituting an unmet clinical need.
Objective
This randomized, double‐blind, placebo‐controlled trial evaluated the ability of omalizumab, a humanized monoclonal anti‐IgE antibody, to improve disease control sufficiently to enable inhaled corticosteroid reduction in patients with severe allergic asthma.
Methods
After a run‐in period when an optimized fluticasone dose (1000 μg/day) was received for 4 weeks, patients were randomized to receive subcutaneous omalizumab [minimum 0.016 mg/kg/IgE (IU/mL) per 4 weeks; n=126] or matching placebo (n=120) at intervals of 2 or 4 weeks. The study comprised a 16‐week add‐on phase of treatment followed by a 16‐week fluticasone‐reduction phase. Short‐/long‐acting β2‐agonists were allowed as needed.
Results
Median reductions in fluticasone dose were significantly greater with omalizumab than placebo: 60% vs. 50% (P=0.003). Some 73.8% and 50.8% of patients, respectively, achieved a 50% dose reduction (P=0.001). Fluticasone dose reduction to 500 μg/day occurred in 60.3% of omalizumab recipients vs. 45.8% of placebo‐treated patients (P=0.026). Through both phases, omalizumab reduced rescue medication requirements, improved asthma symptoms and asthma‐related quality of life compared to placebo.
Conclusion
Omalizumab treatment improves asthma control in severely allergic asthmatics, reducing inhaled corticosteroid requirements without worsening of symptom control or increase in rescue medication use.