Exhaled Nitric Oxide in Children With Asthma Receiving Xolair (Omalizumab), a Monoclonal Anti-Immunoglobulin E Antibody

• Published in: Pediatrics (Evanston) 2004-04, Vol.113 (4), p.e308-e312
• Main Authors: Silkoff, Philip E, Romero, Francisco A, Gupta, Niroo, Townley, Robert G, Milgrom, Henry
• Format: Article
• Language: English
• Subjects: Anti-Asthmatic Agents - administration & dosage; Anti-Asthmatic Agents - therapeutic use; Antibodies, Anti-Idiotypic; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Asthma; Asthma - drug therapy; Asthma - physiopathology; Beclomethasone - administration & dosage; Breath Tests; Care and treatment; Child; Children; Double-Blind Method; Female; Forced Expiratory Volume; Glucocorticoids - administration & dosage; Health aspects; Humans; Immunoglobulin E; Immunoglobulin E - immunology; Male; Nitric oxide; Nitric Oxide - analysis; Omalizumab
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.113.4.e308

To evaluate the effect of a humanized monoclonal antibody to immunoglobulin E, omalizumab (Xolair, Novartis Pharmaceuticals, East Hanover, NJ; Genentech Inc, South San Francisco, CA), on airway inflammation in asthma, as indicated by the fractional concentration of exhaled nitric oxide (FE(NO)), a noninvasive marker of airway inflammation. Xolair was approved recently by the US Food and Drug Administration for moderate-to-severe allergic asthma in adolescents and adults. As an addendum at 2 sites to a randomized, multicenter double-blind, placebo-controlled trial, FE(NO) was assessed in children with allergic asthma over 1 year. There were 3 consecutive study periods: 1) stable dosing of inhaled beclomethasone dipropionate (BDP) when the dose was optimized (period of 16 weeks); 2) inhaled steroid-reduction phase (period of 12 weeks), during which BDP was tapered if subjects remained stable; and 3) open-label extension phase, during which subjects receiving placebo were switched to active omalizumab (period of 24 weeks). The primary outcome was area under the FE(NO) versus time curve (AUC) for adjusted FE(NO), defined as the ratio of FE(NO) at each time point compared with the value at baseline. Twenty-nine subjects participated and were randomized to omalizumab (n = 18) and placebo (n = 11) treatment groups in a 2:1 ratio dictated by the main study. There was a significant difference for age, resulting in a difference in absolute forced expiratory volume in 1 second but no difference in asthma severity based on the forced expiratory volume in 1 second percentage predicted. Baseline BDP dose was comparable between groups, as were baseline values of mean FE(NO) (active: 38.6 +/- 25.6 ppb; placebo: 52.7 +/- 52.9 ppb). The degree of BDP dose reduction during the steroid-reduction and open-label phases was equivalent between the omalizumab and placebo-treated groups; subjects in the omalizumab- and placebo-treated groups had reduced their BDP dose by an average of 51% and 60%, respectively, at the end of the steroid-reduction phase and by 68% and 94%, respectively, by the end of the open-label period. In the active and placebo groups, 44% and 27% and 75% and 73% of subjects had stopped use of inhaled corticosteroids at the end of the steroid-reduction and open-label phases, respectively. There was no significant difference between the active and placebo groups during the steroid-stable phase for AUC of adjusted nitric oxide (1.31 +/- 1.511 vs 1.45 +/- 0.736). H