Long-term efficacy and safety of omalizumab in patients with persistent uncontrolled allergic asthma: a systematic review and meta-analysis.

Tianwen Lai,Wen Li,Zhiwei Xu,Chao Zhang,Shaobin Wang,Chao Cao,Bin Wu,Songmin Ying,Yun Zhao,Zhihua Chen,Yue Hu,Huahao Shen

doi:10.1038/srep08191

Abstract

Currently, limited information is available to clinicians regarding the long-term efficacy of omalizumab treatment for allergic asthma. In this report, we aimed to (i) systematically review the evidence regarding the long-term efficacy of omalizumab in patients with persistent uncontrolled allergic asthma, and to (ii) discuss the cost-effectiveness evidence published for omalizumab in this patient population. A comprehensive search for randomized controlled trials (RCTs; ≥52 weeks) was performed, and six studies met our final inclusion criteria (n = 2,749). Omalizumab was associated with significant improvements in quality of life and the Global Evaluation of Treatment Effectiveness. Omalizumab also allowed patients to completely withdraw from inhaled corticosteroid therapy and did not increase the overall incidence of adverse events. However, there was insufficient evidence that omalizumab reduced the incidence of exacerbations, and the cost-effectiveness of omalizumab varied across studies. Our data indicated that omalizumab use for at least 52 weeks in patients with persistent uncontrolled allergic asthma was accompanied by an acceptable safety profile, but it lacked effect on the asthma exacerbations. Use of omalizumab was associated with a higher cost than conventional therapy, but these increases may be cost-effective if the medication is used in patients with severe allergic asthma.

Highlights

Long-term efficacy and safety of omalizumab in patients with persistent uncontrolled allergic asthma: a systematic review and meta-analysis
Use of omalizumab was associated with a higher cost than conventional therapy, but these increases may be cost-effective if the medication is used in patients with severe allergic asthma
Previous studies and reviews have demonstrated that omalizumab is an effective treatment option for moderate to severe allergic asthma

Summary

Introduction

Long-term efficacy and safety of omalizumab in patients with persistent uncontrolled allergic asthma: a systematic review and meta-analysis. For patients whose asthma remains uncontrolled at this step, GINA recommends adding oral corticosteroids (OCS) or anti-IgE treatment with omalizumab[9]. Omalizumab is an effective intervention as an add-on therapy in the management of severe persistent allergic asthma, important questions remain regarding the role of omalizumab in the treatment of asthma based on current guidelines. Updated National Institute for Health and Care Excellence (NICE 2013) guidelines recommend use only in patients with inadequately controlled severe persistent allergic asthma who require continuous or frequent treatments with oral corticosteroids[16]. This recommendation is not strongly supported by evidence. 52 A worsening of asthma symptoms and was severe enough to require treatment with oral or intravenous corticosteroids or a doubling of the subject’s baseline inhaled BDP dose

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