OMALIZUMAB IS A SAFE, EFFECTIVE TREATMENT AND MAY CONTRIBUTE TO A REDUCTION IN HEALTHCARE UTILIZATION FOR OBSTRUCTIVE AIRWAYS DISEASE DUE TO ASTHMA, COPD, AND ASTHMA-COPD OVERLAP SYNDROME

Abstract

SESSION TITLE: Wednesday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Omalizumab is a recombinant, humanized monoclonal antibody that complexes with free IgE, first approved for the treatment of moderate to severe asthma in 2003. The original study showed a reduction in asthma exacerbations, inhaled corticosteroid and rescue medication use. As more monoclonal antibodies become available for the treatment of asthma, clinicians need guidance on which medication is most effective in each asthma subtype. This retrospective review was performed to assess the safety and efficacy of omalizumab in a real world population of patients at a tertiary Veterans Affairs hospital. We hypothesized that omalizumab would be safe and effective in patients with a history of tobacco use and multiple comorbidities. METHODS: A pharmacy database was queried for all patients prescribed omalizumab at a single center between 1/1/2004 and 8/29/2018, returning 106 patients. The final analysis only included patients who received omalizumab for the first time, were treated for at least 90 days, and the indication was asthma, COPD or asthma and COPD. Prior tobacco exposure was not an exclusion criterion. 14 patients were excluded because they never received the medication, 10 due to starting treatment at an outside facility, 2 as their indication for treatment was urticaria (CIU), 1 as the indication was rhinitis, 1 as the indication was nasal polyposis, 1 as the indication was chronic eosinophilic pneumonia. 70 patients were included in the final analysis. The mean age was 56, 15 (21%) were female, 34 (48.5%) African American, 49 (70%) were current or former smokers, 49 (70%) were obese, 15 (21%) had an FEV1 < 50%, 5 patients had COPD, 13 had asthma and COPD, and 62 had asthma based on ICD coding. RESULTS: There were no instances of angioedema or anaphylaxis in approximately 6000 treatments. Healthcare utilization as measured by chest xrays (108 down to 56), chest CT scans (9 down to 6), emergency department visits (69 down to 43), or hospital admissions (20 down to 13) for respiratory complaints all decreased in the 12 months after initiating treatment. The decrease in healthcare utilization was also seen in subgroups of patients with OSA, obesity, a smoking history and in patients with COPD or asthma-COPD overlap syndrome. CONCLUSIONS: This retrospective analysis adds to the evidence that omalizumab is safe and effective with a new association with decreased healthcare utilization in the 12 months after initiating treatment in patients with smoking histories and multiple comorbidities. CLINICAL IMPLICATIONS: This analysis provides clinicians with data on treatment of a diverse population of patients with smoking histories and multiple comorbidities with omalizumab, reinforcing the safety profile and expanding upon the original conclusion of a decrease in exacerbations with an association with decreased healthcare utilization in the 12 months after initiating treatment. DISCLOSURES: No relevant relationships by Niall Crowley, source=Web Response No relevant relationships by Leonard Moses, source=Web Response