An Update on Severe Asthma
Four Years Clinical Experience with Omalizumab
William W. Storms, M.D.
Colorado Springs, Colorado, USA
Omalizumab became available for use in the United States in 2003. This presentation summarizes the experience at a clinic in Colorado, USA. Initially, omalizumab was given to the most severe chronic asthma patients in the clinic. There were about 25 severe patients started on omalizumab in the fall of 2003. In the spring and summer of 2004 these patients were evaluated and almost all of them had a major improvement in their asthma. At that point more patients were treated with omalizumab and as the word spread to other physicians in the community, pulmonologists and primary physicians referred patients directly for treatment with omalizumab. With these referrals and increasing numbers from the clinic population, over 125 patients have been treated.
Over 125 patients with asthma have been treated with omalizumab in the past 4.5 years in the clinic; 90% of the patients improved in their overall asthma control, quality of life, medication use, etc. About 10% of patients did not improve. This presentation will show the changes in the asthma quality of life scores, spirometry, and reduction in medication usage. Some individual case reports will be used as examples in the presentation. Since some of the patients had other allergic conditions such as eczema or urticaria, those conditions were noted to be improved significantly along with their asthma.
The safety of omalizumab will also be summarized. With over 5,000 injections given there was only one serious systemic reaction; this reaction was generalized pruritus, coughing, and an asthma exacerbation. There were a very small number of patients who had arthralgias, muscle aches, or other systemic symptoms; in some of these patients, the treatment was stopped.
One of the interesting findings has been that the patients' spirometry did not improve; however, their quality of life, symptoms, exercise ability, and general well being improved dramatically in spite of the unchanged FEV1. Patients noted that their usual asthma triggers no longer caused them to have asthma attacks. This included both the allergic triggers and non-allergic triggers and it was interesting to note that the improvement in non-allergic triggers were mentioned by patients very frequently (cigarette smoke, pollution, paint fumes, particulates, etc.). This indicated that omalizumab blocked both the allergic and non-allergic asthma triggers.
Another ancillary finding was that patients with food allergies noted that these food allergies did not bother them as much as they had previously. In summary, omalizumab has been an important adjunctive therapy in patients with severe asthma.