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Omalizumab Is an Effective Intervention in Severe Asthma with Fungal Sensitization
Peter Wark1, Sikandar Hussaini2, Carl Holder3
1Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton, New South Wales, Australia.
Background:
Severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA) are important complications of severe asthma. The evidence for treating them with omalizumab is limited.
Objective:
To determine the effectiveness of treatment with omalizumab in patients with severe allergic asthma comparing those with and without evidence of fungal sensitization using data recorded in the Australian Xolair Registry.
Methods:
Data from 205 patients who received omalizumab and recorded in the Australian Xolair Registry were analyzed to determine change in the Juniper 5-item Asthma Control Questionnaire (ACQ-5) score, exacerbation frequency, and oral corticosteroid dose over a 24-month period of omalizumab treatment. Patients were grouped into cohorts on the basis of fungal sensitization, and an analysis of improvement in outcomes between baseline and 24 months was conducted within each group. A further subgroup analysis of patients with ABPA was also conducted.
Results:
Patients with SAFS (n = 62), including those with ABPA (ASAFS), were as likely to demonstrate significant improvements in ACQ-5 score and exacerbations and reduced regular oral corticosteroid dose over 24 months as those with severe asthma without sensitization to fungi (n = 156). After adjusting for age, sex, body mass index, smoking history, and baseline FEV1%, the effects still remained. A subgroup analysis of 11 patients with ABPA similarly demonstrated a significant improvement on omalizumab.
Conclusions:
Omalizumab is an effective therapy in ASAFS, leading to sustained improvements in symptoms and exacerbations for 24 months. The benefit for ABPA is less clear because of the small sample size.
Insights
Omalizumab effectively improves asthma control and reduces exacerbations in patients with severe asthma and fungal sensitization, including those with allergic bronchopulmonary aspergillosis (ABPA). This therapy offers sustained benefits over 24 months.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Severe asthma is complicated by fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA).
- Limited evidence exists for omalizumab treatment in these specific severe asthma populations.
- Understanding omalizumab's efficacy in fungal-sensitized asthma is crucial for clinical management.
Purpose of the Study:
- To evaluate omalizumab's effectiveness in severe allergic asthma patients with and without fungal sensitization.
- To compare treatment outcomes using data from the Australian Xolair Registry.
- To assess changes in asthma control, exacerbations, and oral corticosteroid use.
Main Methods:
- Analysis of 205 patients receiving omalizumab from the Australian Xolair Registry over 24 months.
- Patients categorized into fungal sensitization (SAFS) and non-sensitization groups.
- Assessment of Juniper 5-item Asthma Control Questionnaire (ACQ-5) scores, exacerbation frequency, and oral corticosteroid dosage.
Main Results:
- Patients with SAFS (n=62), including those with ABPA (ASAFS), showed significant improvements in ACQ-5 scores and reduced exacerbations and oral corticosteroid doses.
- These improvements were sustained over 24 months and remained significant after adjusting for covariates.
- A subgroup analysis of 11 ABPA patients also indicated significant benefits from omalizumab treatment.
Conclusions:
- Omalizumab demonstrates sustained effectiveness in treating severe asthma with fungal sensitization (SAFS), including ASAFS.
- The therapy leads to significant improvements in asthma control and exacerbation rates over 24 months.
- While promising, the benefit of omalizumab for ABPA requires further investigation due to a small sample size.
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