scholarly journals Omalizumab: Clinical Use for the Management of Asthma

2012 ◽  
Vol 6 ◽  
pp. CCRPM.S7793 ◽  
Author(s):  
Neil C. Thomson ◽  
Rekha Chaudhuri
Keyword(s):  
Clinical Trials ◽  
Allergic Asthma ◽  
Inhaled Corticosteroids ◽  
Airway Remodeling ◽  
Final Report ◽  
Duration Of Treatment ◽  
Main Adverse Effect ◽  
Humanized Monoclonal Antibody ◽  
Severe Allergic Asthma ◽  
Long Acting

Omalizumab, a humanized monoclonal antibody that binds circulating IgE antibody, is a treatment option for patients with moderate to severe allergic asthma whose asthma is poorly controlled with inhaled corticosteroids and inhaled long-acting β2 agonist bronchodilators. This review considers the mechanism of action, pharmacokinetics, efficacy, safety and place in management of omalizumab in asthma and focuses particularly on key articles published over the last three years. Omalizumab reduces IgE mediated airway inflammation and its effect on airway remodeling is under investigation. Recent long-term clinical trials confirm the benefits of omalizumab in reducing exacerbations and symptoms in adults and in children with moderate to severe allergic asthma. No clinical or immunological factor consistently predicts a good therapeutic response to omalizumab in allergic asthma. In responders, the duration of treatment is unclear. The main adverse effect of omalizumab is anaphylaxis, although this occurs infrequently. Preliminary data from a five-year safety study has raised concerns about increased cardiovascular events and a final report is awaited. Clinical trials are in progress to determine whether omalizumab has efficacy in the treatment of non-allergic asthma.

scholarly journals IgE-Related Chronic Diseases and Anti-IgE-Based Treatments

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Arnau Navinés-Ferrer ◽  
Eva Serrano-Candelas ◽  
Gustavo-J Molina-Molina ◽  
Margarita Martín
Keyword(s):  
Allergic Asthma ◽  
Chronic Diseases ◽  
Chronic Urticaria ◽  
Inhaled Corticosteroids ◽  
Systemic Mastocytosis ◽  
Airway Remodeling ◽  
Clinical Manifestations ◽  
Allergic Diseases ◽  
Severe Allergic Asthma ◽  
Prophylactic Use

IgE is an immunoglobulin that plays a central role in acute allergic reactions and chronic inflammatory allergic diseases. The development of a drug able to neutralize this antibody represents a breakthrough in the treatment of inflammatory pathologies with a probable allergic basis. This review focuses on IgE-related chronic diseases, such as allergic asthma and chronic urticaria (CU), and on the role of the anti-IgE monoclonal antibody, omalizumab, in their treatment. We also assess the off-label use of omalizumab for other pathologies associated with IgE and report the latest findings concerning this drug and other new related drugs. To date, omalizumab has only been approved for severe allergic asthma and unresponsive chronic urticaria treatments. In allergic asthma, omalizumab has demonstrated its efficacy in reducing the dose of inhaled corticosteroids required by patients, decreasing the number of asthma exacerbations, and limiting the effect on airway remodeling. In CU, omalizumab treatment rapidly improves symptoms and in some cases achieves complete disease remission. In systemic mastocytosis, omalizumab also improves symptoms and its prophylactic use to prevent anaphylactic reactions has also been discussed. In other pathologies such as atopic dermatitis, food allergy, allergic rhinitis, nasal polyposis, and keratoconjunctivitis, omalizumab significantly improves clinical manifestations. Omalizumab acts in two ways: by sequestering free IgE and by accelerating the dissociation of the IgE-Fcεreceptor I complex.

scholarly journals Immunologic Pathophysiology and Airway Remodeling Mechanism in Severe Asthma: Focused on IgE-Mediated Pathways

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 83
Author(s):  
Shih-Lung Cheng
Keyword(s):  
Severe Asthma ◽  
Immunoglobulin E ◽  
Airway Remodeling ◽  
Real Life ◽  
Allergic Diseases ◽  
Proinflammatory Mediators ◽  
Small Subgroup ◽  
Humanized Monoclonal Antibody ◽  
Severe Allergic Asthma ◽  
Ige Mediated

Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remains partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E (IgE) and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating IgE, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be bestowed on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response and as well as extending its indications.

Omalizumab, anti-IgE recombinant humanized monoclonal antibody, for the treatment of severe allergic asthma

2001 ◽  
Vol 108 (2) ◽  
pp. 184-190 ◽  
Author(s):  
William Busse ◽  
Jonathan Corren ◽  
Bobby Quentin Lanier ◽  
Margaret McAlary ◽  
Angel Fowler-Taylor ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Allergic Asthma ◽  
Humanized Monoclonal Antibody ◽  
Severe Allergic Asthma

scholarly journals Predictors of reversible airway obstruction with omalizumab in severe asthma: a real-life study

2019 ◽  
Vol 13 ◽  
pp. 175346661984127 ◽  
Author(s):  
Paolo Solidoro ◽  
Filippo Patrucco ◽  
Francesca de Blasio ◽  
Luisa Brussino ◽  
Michela Bellocchia ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Allergic Asthma ◽  
Severe Asthma ◽  
Airway Remodeling ◽  
Real Life ◽  
Forced Expiratory Volume ◽  
Life Study ◽  
Reversible Airway Obstruction ◽  
Number Of Patients ◽  
Severe Allergic Asthma

Background: Omalizumab may modulate airway remodeling in severe asthma. Using forced expiratory volume in 1 second (FEV1) as a surrogate of airway remodeling, we aimed to investigate if an omalizumab add-on in severe allergic asthma may lead to a persistent reversal of airway obstruction and to evaluate the potential biomarkers of airway obstruction reversibility. Methods: Data were collected before (T0) and after omalizumab add-on for 1 year (T1, 32 patients), 2 years (T2, 26 patients) and 4 years (T4, 13 patients). All patients had baseline FEV1 below 80 % predicted (60.5 ± 12.5 %). After omalizumab, 18 patients showed FEV1 normalization (reversible airway obstruction; RAO+) already at T1 (88.7 ± 14.9 %, p < 0.0001) that persisted up to T4 (83.2 ± 7.9, p < 0.01), while 14 patients (RAO−) had FEV1 persistently decreased, from T1 (65.2 ± 8.4%, p < 0.05) up to T4 (61.4 ± 6.2%, not significant). Both groups had significant improvement of symptoms and exacerbations after omalizumab at T1, which persisted up to T4. The comparison between pretreatment characteristics of the two groups showed that RAO+ patients, had higher values of circulating eosinophils, exhaled nitric oxide (FENO), prevalence of rhinitis and nasal polyps, need of oral corticosteroids, shorter asthma duration, higher FEV1 and response to albuterol test. The optimal cut-off points predicting FEV1 normalization after omalizumab add-on were 30.5 ppb for FENO and 305 cells/µl for eosinophils. Conclusions: This study suggests that omalizumab add-on contributes to the persistent reversal of airway obstruction in a consistent number of patients with severe allergic asthma, and this beneficial effect is predicted by elevated pretreatment FENO and circulating eosinophils.

Omalizumab for severe allergic asthma in clinical trials and real-life studies: What we know and what we should address

2015 ◽  
Vol 31 ◽  
pp. 28-35 ◽  
Author(s):  
Marco Caminati ◽  
Gianenrico Senna ◽  
Massimo Guerriero ◽  
Anna Rita Dama ◽  
Fulvia Chieco-Bianchi ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Allergic Asthma ◽  
Real Life ◽  
Severe Allergic Asthma

scholarly journals The evidence on tiotropium bromide in asthma: from the rationale to the bedside

2019 ◽  
Vol 12 ◽  
Author(s):  
Dejan Radovanovic ◽  
Pierachille Santus ◽  
Francesco Blasi ◽  
Marco Mantero
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Inhaled Corticosteroids ◽  
Airway Remodeling ◽  
Anticholinergic Drug ◽  
Treatment Algorithm ◽  
Anticholinergic Drugs ◽  
Asthma Treatment ◽  
Mucus Production ◽  
Cough Reflex

Severe and poorly controlled asthma still accounts for a great portion of the patients affected. Disease control and future risk management have been identified by international guidelines as the main goals in patients with asthma. The need for new treatment approaches has led to reconsider anticholinergic drugs as an option for asthma treatment. Tiotropium is the first anticholinergic drug that has been approved for children and adults with poorly controlled asthma and is currently considered as an option for steps 4 and 5 of the Global Initiative for Asthma. In large randomized clinical trials enrolling patients with moderate to severe asthma, add-on therapy with tiotropium has demonstrated to be efficacious in improving lung function, decreasing risk of exacerbation and slowing the worsening of disease; accordingly, tiotropium demonstrated to be non inferior compared to long acting beta-agonists in the maintenance treatment along with medium to high inhaled corticosteroids. In view of the numerous ancillary effects acting on inflammation, airway remodeling, mucus production and cough reflex, along with the good safety profile and the broad spectrum of efficacy demonstrated in different disease phenotypes, tiotropium can represent a beneficial alternative in the therapeutic management of poorly controlled asthma. The present extensive narrative review presents the pharmacological and pathophysiological basis that guided the rationale for the introduction of tiotropium in asthma treatment algorithm, with a particular focus on its conventional and unconventional effects; finally, data on tiotropium efficacy and safety. from recent randomized clinical trials performed in all age categories will be extensively discussed.

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