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ASTHMA

Anti-Immunoglobulin E Therapy with Omalizumab for Asthma

Professor, Department of Pharmacy Practice, College of Pharmacy and Pediatric Pulmonary Division, College of Medicine, University of Florida, Gainesville, FL

Christine A Sorkness, PharmD

Professor, Pharmacy Practice Division, School of Pharmacy and Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI

Reprints: Dr. Hendeles, PO Box 100486, Gainesville, FL 32610-0486, fax 352/273-6120, hendeles{at}cop.ufl.edu

OBJECTIVE: To evaluate data on anti-immunoglobulin E (anti-IgE) therapy for asthma.

DATA SOURCES: Information was selected from PubMed from 1989 to May 2007 using the search term omalizumab and included randomized, controlled trials. These studies evaluated asthma treatment with omalizumab and focused on its efficacy, tolerability, and cost-effectiveness in this population.

STUDY SELECTION AND DATA EXTRACTION: All randomized clinical trials were reviewed (23 were identified and 19 were included; 3 were not relevant and 1 contained duplicative data). Other articles using the search words anti-IgE therapy and cost-effectiveness were evaluated; relevant information was extracted.

DATA SYNTHESIS: IgE-dependent mechanisms play an important role in the development and maintenance of airway inflammation in asthma. Omalizumab is a subcutaneously administered monoclonal anti-IgE antibody that reduces unbound IgE concentrations and promotes down-regulation of IgE receptors. Results from clinical trials in adults, adolescents, and children with poorly controlled IgE-mediated asthma have shown that omalizumab improves symptom control and allows patients to be managed with lower doses of inhaled corticosteroids (ICS). It has been well tolerated in clinical trials lasting as long as 52 weeks, but injection-site reactions are common (45% in omalizumab group vs 43% in placebo group) and anaphylaxis has occurred in 0.2% of patients. A consensus expert panel has recommended that omalizumab should be considered for patients 12 years of age or older with allergic asthma who are inadequately controlled on guideline-based therapy and require maintenance therapy with systemic corticosteroids or high-dose ICSs, or who have poor adherence to ICS therapy.

CONCLUSIONS: Anti-IgE therapy provides an effective and generally safe approach to the treatment of patients with IgE-mediated asthma who are not adequately controlled by conventional guideline-based medications. However, the potential benefit must be weighed against the cost and inconvenience of this new therapy.

Key Words: asthma, immunoglobulin E, monoclonal antibody

Published Online, August 14, 2007. www.theannals.com, DOI 10.1345/aph.1K005

This article has been cited by other articles:

				G. Pelaia, T. Renda, P. Romeo, M. T. Busceti, and R. Maselli Review: Omalizumab in the treatment of severe asthma: efficacy and current problems Therapeutic Advances in Respiratory Disease, December 1, 2008; 2(6): 409 - 421. [Abstract] [PDF]