Following up on significant results from a study that demonstrated benefit of pre-treatment with omalizumab prior to initiation of specific allergen immunotherapy (SIT) in subjects with ragweed allergic rhinitis, Massanari et al. report their results from a similarly designed study in subjects with persistent allergic asthma undergoing SIT.
Study subjects with at least moderate persistent allergic asthma that was inadequately controlled by inhaled corticosteroid (ICS) therapy were enrolled to receive 13 weeks pre-treatment with omalizumab or placebo before initiation of 4 weeks cluster regimen SIT followed by 7 weeks of maintenance therapy.
Compared to placebo, the omalizumab group had fewer systemic allergic reactions (SARs) during SIT (placebo: 26.2%; omalizumab: 13.5%), improved asthma symptoms and rescue medication use during pre-treatment, and were more likely to achieve target maintenance dose. Discontinuations due to SARs, were higher in the placebo group (9.6%) than in the omalizumab group (5.0%)
Grade 3 respiratory SARs were most common. Among 30 documented SARs, 24 of the subjects were on placebo and 6 were on omalizumab. Additionally, 87% of the omalizumab group achieved targeted maintenance dose in contrast to 72% of the placebo group.
Do you have any questions for the authors, or comments about this study? We want to hear from you. Please feel free to post your own questions or comments.
Do you have any thoughts on continuing immunotherapy after stopping the omalizumab? A treatment course for long term induction and maintenance of tolerance with immunotherapy would be 3-5 years. We continued one subject on cessation of omalizumab, reducing the dose 10 fold for 3 months post drug, then working back to full maintenance dosing.
ReplyDeleteEFKent
Thomas B. Casale, MD, an author on this paper, gave us this response to Dr. Kent's question: "There have been no formal studies on examining whether one could stop omalizumab once reaching maintenance immunotherapy for either allergic rhinitis or asthma. The most important issue would be a safety concern about potential adverse events. Clearly, this would be much more important in patients with moderate to severe asthma. However, it also appears that the combination is more effective so this would have to be considered as well."
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