11/14/03 Extension of anti-IgE treatment of allergic asthmaSummaryIn a previous 28 week duration randomized, placebo-controlled, multi-institutional study, it was found that treatment with omalizumab, a monoclonal anti-IgE antibody reduced the frequency and severity of exacerbations in patients with severe allergic asthma. Such anti-IgE treatment also allowed them to reduce their use of inhaled corticosteroids (ICS). The current study by Lanier et al was a 24 week extension of that previous study in 460 patients of the original patient group. Using a minimum dose of 0.016 mg/kg of omalizumab, the ICS dosage was reduced to the lowest amount needed for asthma control. They found that the number of patients having at least one asthma exacerbation was significantly reduced in the anti-IgE treated group vs the placebo group (78 vs 92). The anti-IgE treated patients were able to use lower amounts of ICS than the placebo-treated patients. ICS could be withdrawn completely in 27% of the anti-IgE- treated vs 10% of the placebo -treated patients. The mean FEV-1 was 52 ml greater in the anti-IgE treated group at the end of the 24 week extension period. Reference Ann Allergy Asthma Immunol 2003;91:154-59 Editor's Comments The findings in this extension study are fairly similar to that in the earlier study of the same patients. The differences between anti-IgE and placebo treated groups are reportedly statistically significant but not striking. The symptom scores were not different, the FEV-1 improvement was not great and the differences in ICS use were not that impressive. Some would question how often this relatively expensive treatment would be indicated in allergic asthma. Also, I think that I would not call this "long-term" treatment (as stated by the authors) when the total study period was just one year.
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