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The effectiveness and safety of omalizumab in allergic bronchopulmonary aspergillosis

Published: December 26, 2022

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic pulmonary disease resulting from a hypersensitivity reaction to the antigens of Aspergillus fumigatus, colonizing the airways of patients with asthma or cystic fibrosis (CF). Patients with long-standing ABPA have reduced lung function, high rates of hospitalization owing to exacerbations, and worsened respiratory quality of life. Current treatment for ABPA includes the use of oral corticosteroids (OCS) and antifungal drugs, but many ABPA patients still suffer from disease relapse. The introduction of biologic therapies opens a new way for the treatment of ABPA. ABPA patients tend to have an elevated serum total IgE level ( ≥1,000 IU/mL). Omalizumab is a humanized monoclonal antibody that binds to free serum IgE and prevents IgE-mediated inflammatory cascade.  Omalizumab has shown promising effects in case series and small randomized controlled trial studies of ABPA, but evidence to support its routine clinical use is lacking.

Jin et al. conducted systematic review and meta-analysis to evaluate the clinical effectiveness and safety of omalizumab in patients with ABPA and published the article in The Journal of Allergy and Clinical Immunology: In Practice. This study included 49 studies (n = 267 patients) in the qualitative synthesis and 14 case series (n = 186 patients) in the quantitative meta-analysis. The results showed that omalizumab treatment significantly reduced the annualized exacerbation rate compared with pretreatment (mean difference, -2.09 [95% CI, -3.07 to -1.11]; P < 0.01). Omalizumab treatment also contributed to a reduction in OCS use (risk difference, 0.65 [95% CI, 0.46-0.84]; P < 0.01), an increase in termination of OCS use (risk difference, 0.53 [95% CI, 0.24-0.82]; P < 0.01), and a reduction in OCS dose (milligrams per day) (mean difference, -14.62 [95% CI, -19.86 to -9.39]; P < 0.01) in ABPA patients. Furthermore, omalizumab treatment improved FEV1 % predicted by 11.9% (95% CI, 8.2-15.6; P < 0.01) and asthma control. In addition, omalizumab treatment was well-tolerated in ABPA patients.

The results highlight the potential role of omalizumab in the treatment of ABPA.

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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