Small, Prospective, Observational, Pilot Study in Patients with Severe Asthma after Discontinuation of Omalizumab Treatment

• Published in: Clinical therapeutics 2018-11, Vol.40 (11), p.1942-1953
• Main Authors: Krčmová, Irena, Novosad, Jakub, Malá, Eva, Krejsek, Jan
• Format: Article
• Language: English
• Subjects: Allergies; Asthma; Asthma Control Test; Clinical trials; Corticosteroids; Data collection; FDA approval; Immunoglobulin E; Immunotherapy; Inflammation; inhaled corticosteroids; Laboratories; Laboratory tests; Leukocytes (eosinophilic); Monoclonal antibodies; Nitric oxide; Normality; omalizumab; Patients; Pulmonary functions; Quality of life; Rank tests; severe asthma; skin prick test; Skin tests; Statistical analysis; Variance analysis
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2018.09.004

Omalizumab has demonstrated clinical efficacy in severe allergic asthma by reducing exacerbation rates and increasing quality of life. However, data concerning its sustained effect after treatment discontinuation are still needed. : This analysis was an observational pilot study (simple within-subjects design) of 12 patients experiencing severe asthma, treated with omalizumab, for 1 year after treatment discontinuation. We prospectively analyzed clinical measurements (pulmonary functions, inhaled corticosteroid [ICS] doses, Asthma Control Test [ACT] scores, skin prick test [SPT] positivity, fraction of exhaled nitric oxide, and exacerbation rates) and laboratory test results (eosinophils and total immunoglobulin E levels) at the time of discontinuation and 6 and 12 months thereafter. Baseline data (before the treatment period; range, 11–61 months) were collected retrospectively. The treatment effect until discontinuation was calculated. To determine its persistence, repeated measures were compared with baseline levels and analyzed by using a general linear model for repeated measures or the Friedman ANOVA, and χ2 tests in case of normality assumption violation or frequencies. Post hoc analysis was applied by using a simple or repeated contrasts analysis or Wilcoxon signed rank test with Bonferroni correction. : We proved a significant reduction in ICS doses and SPT reactivity and an increase in ACT score during the retrospective treatment phase. Moreover, persistence of these statistically significant effects was recorded 6 months after treatment discontinuation. ACT score and ICS doses (but not SPT reactivity) remained improved for 12 months after discontinuation of omalizumab treatment. Omalizumab treatment exhibited sustained treatment benefit after its discontinuation for patients experiencing severe allergic asthma.