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Factors reducing omalizumab response in severe asthma

Published:February 03, 2018DOI:https://doi.org/10.1016/j.ejim.2018.01.026

      Highlights

      • A fair proportion of severe asthmatics may have a reduced Omalizumab response.
      • Several factors may reduce Omalizumab effectiveness in these patients.
      • They are: age, obesity, comorbidities, smoking, nasal polyps, polysensitization.
      • These factors act independently of many asthma-influencing variables.
      • When managing these patients, we should consider multidisciplinary interventions.

      Abstract

      Background

      Despite adding Omalizumab to conventional therapy, several severe asthmatics still show poor disease control. We investigated the factors that may affect a reduced Omalizumab response in a large population of severe asthmatics.

      Methods

      340 patients were retrospectively evaluated. FEV1%, FVC%, Asthma Control Test (ACT), fractional exhaled nitric oxide (FENO), possible step-downs/step-ups of concomitant therapies, exacerbations, disease control levels, ICS doses and SABA use, observed at the end of treatment, were considered as a response to Omalizumab.

      Results

      Age was an independent risk factor for a reduced response concerning FEV1%, FVC%, ACT and for a lower asthma control. Obesity (vs normal weight) was a determinant condition for exacerbations (OR:3.114[1.509–6.424], p = 0.002), for a disease partial/no control (OR:2.665[1.064–6.680], p = 0.036), for excessive SABA use (OR:4.448[1.837–10.768], p = 0.002) and for an unchanged/increased level of concomitant asthma medications. Furthermore, obesity also reduced the response in FEV1 (β = −6.981,p = 0.04), FVC (β = −11.689,p = 0.014) and ACT (β = −2.585, p = 0.027) and was associated with a higher FENO level (β = 49.045,p = 0.040). Having at least one comorbidity was a risk factor for exacerbations (OR:1.383[1.128–1.697], p = 0.008) and for an ACT <20 (OR:2.410[1.071–3.690], p = 0.008). Specifically, chronic heart disease was associated with both a lower ACT and FVC% whereas gastroesophageal reflux with a partial/no asthma control. Nasal polyps were a predisposing factor leading both to exacerbations and to the use of higher inhaled corticosteroids doses. Moreover, smoking habits, pollen or dog/cat dander co-sensitizations may negatively influence Omalizumab response.

      Conclusion

      Age, obesity, comorbidities, smoking habits, nasal polyps, allergic poly-sensitization might reduce Omalizumab effectiveness independently to other asthma-influencing factors.

      Keywords

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