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Response to omalizumab in children by asthma severity

Published online: April 13, 2020

Inadequately controlled childhood asthma negatively affects physical and social function, health-related quality of life, school attendance and health care resource utilization. Although high-dose inhaled corticosteroids (ICS) and long-acting β2-agonists are recommended in severe, uncontrolled asthma, they may not be effective in improving asthma control in some children. Omalizumab has been shown to significantly reduce exacerbations and improve asthma control in children with moderate-to-severe persistent asthma and is approved in the US to treat patients aged 6 years and older with moderate-to-severe allergic asthma that is inadequately controlled with ICS.

In a recently published article in The Journal of Allergy and Clinical Immunology: In Practice, Szefler and colleagues analyzed if levels (“high” or “low”) of fractional exhaled nitric oxide (FeNO), body mass index (BMI), lung function, eosinophil count, prior hospitalizations and prior asthma exacerbations affected the response to omalizumab. This analysis used data from children aged 6-11 years with uncontrolled moderate-to-severe asthma from three placebo-controlled studies of omalizumab.

The present analyses found that omalizumab reduced the number of exacerbations compared to placebo across all severity subgroups. The reduction in exacerbations was greater for patients with high eosinophil counts and FeNO levels, and in patients with a high BMI percentile, when compared to their respective comparison groups. Furthermore, the reduction in exacerbations was greater in patients with more severe asthma as indicated by low baseline lung function, frequent exacerbations in the year prior to starting omalizumab, and prior hospitalizations.

This post hoc analysis of pivotal trials of omalizumab by Szefler and colleagues supports the use of omalizumab in children with uncontrolled moderate-to-severe allergic asthma, and further highlights the association between asthma severity and therapeutic response to omalizumab.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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