Omalizumab

#Omalizumab efficacy not affected by #blood eosinophil count

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  • Noticias Médicas Univadis

In patients with severe allergic asthma (SAA), omalizumab is equally effective in those with high and low blood eosinophil count, according to research published in the European Respiratory Journal.

The study used the medical records of 872 patients (including 149 minors) with SAA receiving add-on omalizumab. Response was assessed by three criteria: physician evaluation, reduction of at least 40 per cent in annual exacerbation rate, and a combination of both. Response rate was calculated according to blood eosinophil count measured in the year prior to omalizumab initiation.

Blood eosinophil count was ≥300cells/µL in more than 52 per cent of adults and almost 74 per cent of minors. By physician evaluation, 67.2 per cent of adults and 77.2 per cent of minors were responders. Over 70 per cent of adults and 78.5 per cent of minors had a reduction in exacerbation rate of at least 40 per cent. In adults, the response rate for combined criteria was 58.4 per cent for blood eosinophils ≥300cells/µL and 58.1 per cent for blood eosinophils <300cells/µL.

The authors say the findings deserve to be further investigated in prospective studies assessing the effectiveness of biologics targeting overlapping populations of patients with persistent SAA and high eosinophil count.

#Omalizumab may improve the efficacy of #food desensitisation in children

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Findings from a new trial suggest omalizumab improves the efficacy of multifood oral immunotherapy and enables safe and rapid desensitisation.

As part of the trial, published in The Lancet Gastroenterology & Hepatology, 48 children aged 4-15 years, with multifood allergies were given omalizumab (n=36) or placebo (n=12) for 16 weeks. Eight weeks into treatment, they began food desensitisation for two to five trigger foods until week 36 of the trial.

On average, children on omalizumab tolerated higher levels of trigger food protein in the first week of desensitisation, compared to children given placebo (250mg vs 11mg per food), and were able to tolerate the highest dose of their trigger food protein (2g) sooner (12 vs 20 weeks). 

Writing in a linked comment, Professor Lars K Poulsen, Copenhagen University Hospital at Gentofte, Denmark, described how the current food allergy epidemic appears to be a “perfect storm involving an increased prevalence of sensitised children, an increased severity profile, and a broadening of reactivity from fewer to more allergenic foods”. Dr Poulsen said, by including participants with a high level of sensitisation, the study addresses the most severely affected and thus difficult-to-treat part of the food allergic population.

Andorf S, Purington N, Block WM et al. Anti-IgE treatment with oral immunotherapy in multifood allergic participants: a double-blind, randomised, controlled trial.  Lancet Gastroenterol Hepatol 2017. Published online December 11, 2017. Doi: 10.1016/ S2468-1253(17)30392-8.

Poulsen LK. Food allergy: setting the scene for tolerance induction. Lancet Gastroenterol Hepatol  2017. Published online December 11, 2017. http://dx.doi.org/10.1016/ S2468-1253(17)30391-6.

Omalizumab effectively treats cold urticaria and symptomatic dermographism

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Omalizumab was well tolerated in patients with cold urticaria who were unresponsive to antihistamines.

Findings from two separate clinical studies, published in the Journal of Allergy and Clinical Immunology , suggest the monoclonal antibody, omalizumab is highly effective against different types of urticaria.

As part of two investigator-initiated, multicentre, randomised, placebo-controlled trials, researchers from Charité-Universitätsmedizin Berlin used omalizumab to treat two different patient groups; 61 patients with symptomatic dermographism and 31 patients with cold urticaria, for a period of three months.

They found treatment with omalizumab led to significant improvements in symptoms in both groups of patients, and prevented symptoms in nearly half of all patients with cold urticaria and symptomatic dermographism, even after exposure to relevant stimuli. Treatment was well tolerated in cold urticaria patients unresponsive to antihistamines.

“Our results show that patients with severe forms of physical urticaria can benefit from treatment with omalizumab,” says Prof. Martin Metz. While the drug is licensed in Europe for use in patients with chronic spontaneous urticaria, Prof Metz said “given our data on the drug’s effectiveness in patients with cold urticaria and symptomatic dermographism, we are hopeful that the drug will be made available to both of these patient groups.”