Abstract
Introductions: Cystic fibrosis (CF) patients with allergic bronchopulmonary aspergillosis (ABPA) are mainly treated with systemic corticosteroids (SCS). However, SCS are well known for serious side effects. Some reports suggest that omalizumab may be associated with improved outcomes and SCS sparing. Aim: The present study assesses the impact of omalizumab on clinical outcomes in a cohort of CF patients with ABPA. Methods: A chart review was performed for the period of 2010 to 2014. CF patients with ABPA treated with SCS patients were compared with patients with omalizumab. Outcomes included FEV1, exacerbations, need for SCS and IgE level. Results: 22 of the 314 CF patients have ABPA, of which 17 were on long-term SCS. 12 patients were considered for omalizumab by the CF team but only 5 received at least one year of omalizumab. Patients selected to receive omaluzimab were on higher doses of prednisone (daily mean of 12,4 mg vs 9,2 mg) and had more exacerbations (4,5 vs 2,47/y). 4 patients on omalizumab were able to completely stop prednisone and one reduced prednisone by 50%. Rates of exacerbations were decreased by 30 to 60% in the first year after starting omalizumab. On long-term anti-IgE treatment, exacerbation rates were even further reduced. No decline in FEV1 was observed despite the removal of SCS in the omalizumab group. Serum total IgE decreased after one year on omalizumab (1416 vs 1239 kUI/L). Conclusion: Omalizumab was associated with reduced exacerbations, stabilization in FEV1 and a reduced dose of SCS.
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