Q:

8/19/2013
I have a 36 yo severe persistent asthmatic unable to obtain control on standard therapy with high dose inhaled steroids and has required many years of daily prednisone 20-40mg from which she is now suffering multiple side effects. I am interested in initiating omalizumab but she falls outside of the dosing guidelines due to morbid obesity (weight 173 kg) although her IgE is within dosing at 343 IU/mL. I have read 2 case reports in pediatric patients with morbid obesity suggesting efficacy and no serious adverse events. I was considering proceeding with 300mg q 2 weeks which is based on her IgE level. Would you proceed with omalizumab in this case and at what dose?

A:

Thank you for your inquiry.

You are correct in that there are reports in the literature of improvement in asthma in patients whose weight places them outside of the normal dosage range for omalizumab. In addition, there are reports of improvement in patients whose IgE levels place them outside the normal dosage range. Thus there is precedence for starting omalizumab therapy in uncontrolled asthmatics who do not fit into the normal dosing schedule suggested by the package insert.

In my opinion, omalizumab would be worth a trial, and I would suggest starting with a minimum dose of 300 mg every two weeks.

Thank you again for your inquiry and we hope this response is helpful to you.

References:
1. J Asthma 2010; 47(8):942-5.
2. Asian Pac J Allergy Immunol 2009; 27(4):233-6.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology