Preseasonal treatment with either Omalizumab prevents fall asthma exacerbations

In spite of optimal guidelines-based asthma treatment many children and adolescents with asthma continue to experience exacerbations. Asthma exacerbations have serious consequences, from increased morbidity to disease progression. While exacerbations can occur at any time to any patient, children with advanced disease, greater degrees of atopy, or who have experienced a recent exacerbation appear most susceptible to further exacerbation, and the time of year in which it is most likely to occur is in the autumn.

Previous Inner-City Asthma Consortium (ICAC) studies demonstrated higher daily doses of inhaled corticosteroids (ICSs) or the addition of omalizumab to year-round treatment reduced exacerbation frequency. Continuous treatment with either, however, risks side effects and incurs financial cost. Teach et al. have examined a seasonal, preventive approach, finding the addition of omalizumab four to six weeks prior to the start of school to ongoing guidelines-based management significantly reduces autumn exacerbation occurrence (J Allergy Clin Immunol 2015; 136(6): 1476-1485).

The authors compared the effects of preseasonal treatment with either omalizumab, an ICS boost or placebo in inner-city asthmatic children aged 6 to 17 years who had experienced one or more exacerbations in the 19 months prior. Patients completed a four- to nine-month run-in phase following study enrollment, during which they received guidelines-based care intended to achieve asthma control. Four to six weeks before the start of the school year and the autumn season, they initiated omalizumab, ICS boost, or placebo which continued through the first  90 days of each child’s school year.

The rate of exacerbations in autumn among the children who had received either omalizumab was significantly lower than among the children who had received a placebo. Among the children who had experienced an exacerbation during the run-in phase, omalizumab proved significantly more effective in preventing an exacerbation than ICS boost or placebo with a greater than 80% protection rate. Adverse events across all groups were rare and similar.

      Such a seasonal approach in treatment adjustment represents a first-time report of a novel strategy, indeed suggesting a paradigm shift, in confronting the “September epidemic” of asthma. Those who have experienced a recent exacerbation respond better to Omalizumab.