Omalizumab is an effective intervention in severe asthma with aspergillus sensitisation

Abstract

Background: Severe asthma with fungal sensitisation (SAFS) and allergic bronchopulmonary aspergillosis (ABPA) are important complications of severe asthma. The evidence for treating them with omalizumab is limited. Objective: To determine the effectiveness of treatment with omalizumab in severe allergic asthma patients comparing those with and without evidence of fungal sensitisation using data recorded in the Australian Xolair registry. Methods: Data from the Australian Xolair Registry (AXR) was analysed to determine change in Asthma Control Questionnaire (ACQ-5) score, exacerbation frequency, and oral corticosteroid (OCS) dosage over a 24 month period of omalizumab treatment. Patients were grouped into cohorts based on fungal sensitisation, and an analysis of improvement in outcomes between baseline and 24 months was conducted within each group. A further subgroup analysis of patients with ABPA was also conducted. Results: SAFS and non-fungal sensitized (NFS) both demonstrated significant improvements in ACQ-5, exacerbations and reduced regular oral corticosteroid dose over the 24-month period of omalizumab treatment. After adjusting for age, sex, BMI, smoking history, visit and baseline FEV1% predicted there was no significant difference in improvements between the two cohorts. A subgroup analysis of ABPA patients similarly demonstrated significant improvement on omalizumab. Conclusion: Omalizumab is an effective therapy in SAFS, leading to sustained improvements in symptoms and exacerbations for 24 months. Omalizumab seems to provide significant benefit in ABPA.