Xolair May Work for Nonallergic Asthma, Too (CME/CE)

Published: Aug 11, 2013 | Up-to-date: Aug 12, 2013

The particular monoclonal antibody omalizumab (Xolair), utilized for allergic asthma, may be ideal for nonallergic cases as well, a proof-of-concept study showed.

Within serious, refractory nonatopic asthma, the drug efficiently turned down immunoglobulin Electronic receptor levels in inflamed immune tissues, Marc Humbert, MD, PhD, involving Hôpital alle de Bicêtre, France, and colleagues found.

The drug also reduced the amount of airway blockage, with a 9. 9% improvement in forced expiratory volume in 1 2nd (FEV one ) over primary, the researchers reported in the August issue of Chest.

“Omalizumab might have a therapeutic part in severe nonatopic asthma, ” they suggested, saying the information warrants further analysis of clinical effectiveness, for which the tiny pilot study was not properly powered.

This included 41 adults with severe, nonatopic asthma uncontrolled by Global Effort for Asthma guidelines regardless of daily treatment having a high-dose inhaled corticosteroid along with a long-acting beta agonist that showed no clinical or laboratory proof of reactivity to common year-round allergens, such as dirt mites, ragweed, cat and nu dander, and timothy lawn.

Most of the 20 patients randomized to obtain omalizumab showed at least a 50% decrease in high-affinity IgE receptor in blood basophils and in plasmacytoid dendritic tissues after 16 weeks.

For your main endpoint, the average reduction was 90% in basophils and 56% in dendritic cells within the anti-IgE monoclonal antibody compared to 10% and 4%, respectively, among those randomized into a matched placebo (both P < 0. 001).

In terms of clinical endpoints, FEV one flower by a mean two hundred and fifty mL, or 9. 7% forecasted, in those upon omalizumab compared with no change, and 0. 2% forecasted worsening, within the placebo group ( P =0. 032).

The number of asthma exacerbations within the 16-week period was not significantly different, although it and the percentage of patients having an exacerbation favored omalizumab numerically (0. 85 versus one 43 and 60% as opposed to 48%).

“This interesting trend (suggesting an effect on exacerbations) could have been statistically significant if a longer treatment duration (e. gary the gadget guy., 6 months) was used, ” Humbert’s group mentioned.

The change in asthma symptoms didn’t correlate with the high-affinity IgE receptor appearance on the circulating inflamed cells examined, as true in serious atopic asthma additionally.

Some prior studies have suggested that there may be local IgE generation directed against unknown antigens in atopic asthma, the researchers mentioned.

“Although we expect that this population represents a true nonallergic cohort that was tested extensively with regard to known common contaminants, it is nevertheless possible that a few of the study topics were sensitized to unknown (or unidentifiable) contaminants, ” they published.

Their own trial was restricted to lack of testing for allergy to Cladosporium , Trichophyton , or Candida fungus , “all which have been linked to difficult-to-treat asthma, ” and Staphylococcus aureus superantigen as a risk factor with regard to severe asthma.

Other limitations were the tiny sample size as well as the higher body mass index and lower initial FEV one within the omalizumab group, which may get lent more room with regard to enhancement.

The study was supported by Novartis Pharma.

Humbert reported having been a consultant and a speaker at conferences with regard to AstraZeneca, GlaxoSmithKline, and Novartis and having served as a consultant with regard to Merck


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