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Abstract
Introduction: Immunoglobulin E dependent mechanisms play an important role in the development of airway inflammation in allergic asthma. Atopic patients with severe asthma frequently have poorly controlled disease. Many have poor asthma control despite intensive treatment. Severe allergic asthma patients frequently treated with oral corticosteroids and therefore may develop serious side-effects. Anti-IgE antibody had been used in severe persistent allergic asthma in Western countries. However, its long-term efficacy in patients in India has not been reported. Objective: To assess the efficacy of anti IgE therapy in patients with severe allergic asthma. Method: 30 (16 male and 14 female) patients, with mean age of 49 having severe persistent allergic asthma, with recurrent exacerbations and on oral/IV steroids, received Omalizumab 150mg/300mg/450 mg for 1 year. Total dose of oral Steroids, use of rescue medications, changes in lung function (FEV1) were recorded at the baseline, 16 weeks & at end of the treatment (52 weeks) and then analyzed. Results: Significant reduction observed in total oral steroid use at 16 week & at 52 weeks. -10.5mg (p<0.003) & 22.5mg respectively. Use of rescue medications decreased by -7.90 puffs(p- <0.001) at 16 weeks and by -13.67 puffs (13.67 (p -<0.001) at 52 weeks. Improvements in lung Function (FEV1) observed with a tune of 700 ml. from Baseline after 52 weeks therapy. Conclusion: Use of anti-IgE antibody for 1 year is well tolerated and led to an overall significant improvement in patients with severe persistent allergic asthma.
Highlights
Immunoglobulin E dependent mechanisms play an important role in the development of airway inflammation in allergic asthma
A Cochrane review published in 2006 by Walker S, Monteil M, Phelan K, Lasserson T, Walters E of 14 randomized controlled trials in 3143 children and adults with mild to severe allergic asthma found that treatment with omalizumab reduced asthma exacerbations and increased the proportion of patients who were able to reduce or withdraw inhaled corticosteroids [8]
A systematic review published in 2011 by Rodrigo GJ, Neffen H, Castro-Rodriguez J. of 8 randomized controlled trials in 3,429 children and adults with moderate to severe allergic asthma taking inhaled corticosteroids, including two trials published after 2006 [10,11] concluded that omalizumab treatment resulted in a higher proportion of subjects steppingdown and stopping inhaled corticosteroids (Relative risk [RR] = 1.80; 95% CI, 1.42–2.28) and reduced the risk of asthma exacerbations (RR = 0.57; 95% CI, 0.48–0.66) [9]
Summary
Asthma remains a major public health problem and a significant proportion of patients have severe, persistent disease that is refractory to continuous treatment, even with a combination of high-dose inhaled corticosteroids and long-acting b2-agonists. Several studies have demonstrated the therapeutic efficacy and safety of omalizumab in asthmatic patients and have found a reduced annual rate of clinically significant asthma exacerbations, systemic requirements of corticosteroids, emergency department (ED) visits, and overall symptoms [1,3,4,5]. This therapy has been incorporated into the current guidelines for the treatment of asthma. These allergens cause the passages in the airways of the lungs to become inflamed and swollen This results in coughing, wheezing and other asthma symptoms. The definition of severe asthma (according to ERS/ATS 2014) is that group of patients who needs treatment with high-dose ICS + at least one additional controller (LABA, montelukast, or the ophylline) or oral corticosteroids >6 months/year
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