Written by Babatunde Carew
Spoon Feed
In patients with asthma inadequately controlled on high-dose inhaled corticosteroids (ICS) and long acting beta agonists (LABAs), omalizumab significantly reduces symptom burden.
Omalizumab, an IgE-nius therapy for asthma
Severe asthma – poor control despite high-dose ICS and LABA therapy – affects just 3–10% of adults with asthma, but drives over 60% of related healthcare costs due to high disease burden, highlighting the need for more effective treatment.
This double-blind, placebo-controlled randomized trial evaluated omalizumab (a monoclonal anti-IgE antibody) in 850 patients aged 12-75 with severe asthma inadequately controlled on high-dose ICS and LABAs +/- other controller medications (e.g. montelukast). Over 48 weeks, omalizumab reduced asthma exacerbations by 25% compared to placebo (0.66 vs. 0.88; p=0.006), improved quality of life, and lowered albuterol use. Adverse events were comparable between groups. Limitations include the relatively small trial size and short follow-up period, which may decrease the detection of rare safety events like anaphylaxis and malignancy.
How does this change my practice?
This study changes my practice. For patients with severe asthma uncontrolled on ICS/LABA therapy, I’m more likely to refer for omalizumab evaluation earlier, given the proven benefit in reducing exacerbations and favorable safety profile. Rather than trialing marginal add-ons like montelukast or theophylline, I think a shift to prioritizing targeted biologics will become the norm.
Source
Omalizumab in severe allergic asthma inadequately controlled with standard therapy: a randomized trial. Ann Intern Med. 2011 May 3;154(9):573-82. doi: 10.7326/0003-4819-154-9-201105030-00002. Erratum in: Ann Intern Med. 2019 Oct 1;171(7):528. doi: 10.7326/L19-0549. PMID: 21536936
