October 27, 2015
Published in JACI: New Asthma Treatment Strategy With Omalizumab Targets Fall Exacerbations Before They Begin
Researchers’ introduce biologic treatments for asthmatics prone to exacerbations
MILWAUKEE, WI – By beginning treatment with omalizumab weeks before the first day of class, a team of researchers came across a novel, preventative strategy for fall asthma exacerbations. Their research was published this week in The Journal of Allergy and Clinical Immunology (JACI).
“Our study shows that an effective, preventative strategy for fall exacerbations can be achieved with targeted, seasonal treatment using omalizumab, suggesting a paradigm shift for managing high risk patients,” first author Stephen J. Teach, MD, MPH, with Children’s National Health System in Washington, DC, said.
A three-arm, randomized, blinded, double placebo-controlled, multi-center clinical trial was conducted among inner-city asthmatic children aged 6-17 years old who had more than one recent exacerbation during the fall seasons of 2012 and 2013. Doctors compared omalizumab to a placebo and also compared omalizumab to a boost in inhaled corticosteroids. These interventions were added to ongoing, guidelines-based treatment beginning 4 to 6 weeks before school started and running through day 90 after the school start date.
Researchers found that the exacerbation rate was significantly lower in the omalizumab group when compared to the placebo (11.3 % vs. 21.0%). Among those who had an exacerbation during the asthma guidelines-based enrollment period before the fall season, omalizumab was significantly more effective in preventing future exacerbations. For example, 6.4% had exacerbations while using omalizumab vs 36.3% who had exacerbations using only the placebo; 2.0% had exacerbations while using omalizumab vs. 27.8% who had exacerbations using only the inhaled corticosteroid boost.
“A challenge to the use of biologic agents in asthma is to select the patients most likely to respond to these treatments,” Teach explained, adding that patients with recent or recurrent exacerbations would best benefit from pre-seasonal treatments with omalizumab.
Omalizumab is a biologic agent that removes free circulating Immunoglobulin E (IgE), an antibody that is involved with allergies and allergic inflammation. IgE may also play an important role in the escalation of a rhinovirus infection to an asthma exacerbation by causing inflammation. Thus, the preventative effects of omalizumab may be due to suppression of both allergic and virus-associated inflammation.
This study was funded by the National Institute of Allergy and Infectious Diseases, the National Institutes of Health, the Department of Health and Human Services, the National Center for Research Resources and the National Center for Advancing Translational Sciences.
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