Effects of omalizumab in severe asthmatics across ages: A real life Italian experience

Sposato, Bruno; Scalese, Marco; Latorre, Manuela; Scichilone, Nicola; Matucci, Andrea; Milanese, Manlio; Masieri, Simonetta; Rolla, Giovanni; Steinhilber, Gundi; Rosati, Y.; Vultaggio, Alessandra; Folletti, Ilenia; Baglioni, Stefano; Bargagli, Elena; Tomassi, M. Di; Pı́o, Rubén; A, Pío; Maccari, Uberto; Maggiorelli, Claudia; Migliorini, Maria Giovanna; Vignale, L; Pulerá, Nolita; Carpagnano, Giovanna Elisiana; Barbaro, Maria Pia Foschino; Perrella, Antonio; Paggiaro, Pierluigi

doi:10.1016/j.rmed.2016.09.005

Cited by 36 publications

(25 citation statements)

References 48 publications

(59 reference statements)

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“…Our prior review provided strong evidence for the short-term (16 weeks to 1 year) effectiveness of omalizumab, and emergent yet still tentative evidence that the effectiveness may extend up to 2 to 4 years. This present review firmly establishes the short-term effectiveness of omalizumab at 16 weeks and 1 year, and provides strong evidence of its long-term effectiveness: seven studies reported outcomes at 2 years [37,39,43,45,60,70,76], seven studies at 3 years or more [36,47,58,63,64,66,70,73], one study at 4 years [36], and one study with a mean follow-up of 60.7 months followed patients for as long as 121 months [66]. Thus, our review provides strong evidence on the major outcomes of interest for up to 2 to 4 years; and emergent evidence reaching well beyond 4 years.…”

Section: Expert Commentarysupporting

confidence: 65%

“…To minimize bias, non-significant results reported in the original publication were included in our pooled estimates. Table 1 summarizes the 42 studies stratified by 30 adult-only studies [24,26,27,[30][31][32][33][34][35][36][37][40][41][42][43][44][45][46][47][58][59][60][61][62][63][64][65][66][67][68] (n = 3558) and 12 adult/ adolescent studies [25,38,39,56,57,[69][70][71][72][73][74][75][76][77] (n = 5819). These 42 studies comprised a total of 9377 patients from 35 countries: 25 in Europe (incl.…”

Section: Other Methodological Considerationsmentioning

confidence: 99%

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Short- and long-term real-world effectiveness of omalizumab in severe allergic asthma: systematic review of 42 studies published 2008-2018

MacDonald

Kavati

Ortiz

et al. 2019

Expert Review of Clinical Immunology

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Introduction: Omalizumab is a recombinant monoclonal anti-IgE antibody approved in the US as add-on treatment in moderate-to-severe allergic asthma (in severe allergic asthma [SAA] in Europe). A 2016 review of 24 real-world effectiveness studies in SAA published between 2008-2015 concluded that omalizumab was associated with significant improvements in objective and subjective outcomes with benefits extending beyond 2 years. Several new real-world studies have been published since, bringing the total to 42 studies. Areas covered: This systematic review of 42 studies published since 2008 updates and extends the 2016 review on the real-word evidence on omalizumab in SAA. It offers greater granularity as to time windows within which outcomes are reported and includes studies extending well beyond 4 years post omalizumab initiation. Expert commentary: This review firmly establishes the short-term effectiveness of omalizumab in adolescent and adult patients with SAA at 1 year, and provides strong evidence of long-term effectiveness up to 4 years and emergent evidence of effectiveness beyond 4 years. In the aggregate, these 42 studies underscore the long-term effectiveness of omalizumab in terms of: reducing exacerbations and symptoms, achieving asthma control, improving lung function, enhancing quality of life, decreasing emergency department visits and hospitalizations, and promoting concomitant medication-sparing. ARTICLE HISTORY

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Section: Expert Commentarysupporting

confidence: 65%

Section: Other Methodological Considerationsmentioning

confidence: 99%

Short- and long-term real-world effectiveness of omalizumab in severe allergic asthma: systematic review of 42 studies published 2008-2018

MacDonald

Kavati

Ortiz

et al. 2019

Expert Review of Clinical Immunology

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“…More recently, montelukast among elderly patients with severe asthma was shown to be moderately efficacious in improving asthma control days and reducing rescue medication use . Some older patients with asthma have demonstrated clinical improvement after treatment with anti‐IgE (omalizumab) therapy, although the response may be less than in younger patients …”

Section: Pharmacologic Managementmentioning

confidence: 99%

Asthma in the elderly and late‐onset adult asthma

Dunn

Busse

Wechsler

2017

Allergy

148

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Elderly asthmatics are at a higher risk for morbidity and mortality from their asthma than younger patients. There are important age-related physiologic and immunologic changes that complicate the presentation, diagnosis, and management of asthma in the aged population. Evidence suggests that elderly asthmatics are more likely to be underdiagnosed and undertreated. Additionally, elderly patients with asthma have highest rates of morbidity and mortality from their disease than younger patients.

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“… 132 Omalizumab improves all asthma outcomes independently of age, although the magnitude of the effects observed in the elderly seems to be lower than in other age groups. 133 Post hoc analyses of the anti-IgE agent omalizumab indicate similar efficacy in both younger and older adults. Anti-IL-5 and anti-IL-13 therapy appear to show even more pronounced effects as targeted treatments in late-onset disease and in asthmatic patients 65 years or older, but evidence is lacking.…”

Section: Introductionmentioning

confidence: 98%

Late-onset asthma: current perspectives

Hirano¹,

Matsunaga²

2018

JAA

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Because the pathophysiology of asthma has diverse characteristics, to manage the disease effectively, it is important for clinicians to distinguish among the clinical phenotypes. Among them, adult-onset asthma, that is, late-onset asthma (LOA), is increasing because of the aging of the population. The phenotype of LOA is largely divided into two types according to the presence or absence of eosinophilic inflammation, T-helper (Th)2- and non–Th2-associated LOA. Especially in Th2 LOA related to rhinosinusitis, as pulmonary function at onset is poor and asthma exacerbations occur frequently, it is important to detect this phenotype in the early phase by using a biomarker of Th2-type inflammation such as fractional exhaled nitric oxide (FENO). As non–Th2-LOA is often resistant to corticosteroids, this phenotype often requires another treatment strategy such as macrolide, diet, or smoking cessation. We often struggle with the management of LOA patients due to a lack of evidence; therefore, the elucidation of the mechanism of LOA contributes to increased efficiency of diagnosis and treatment of LOA. Age-related immune system and structural changes are thought to be associated with the pathophysiology of LOA. In the former case, changes in inflammatory cell function such as variations in the innate immune response and acquisition of autoimmunity or upregulation of oxidative stress are thought to be involved in the mechanism. Meanwhile, the latter can also become triggers or exacerbating factors of LOA via enhancement of airway hyperresponsiveness, decline in lung function, increased air trapping, and reduction in chest wall compliance. Therefore, appropriate individualized management in LOA may be possible through precisely assessing the pathophysiology based on age-related functional changes, including the immune and structural system.

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Effects of omalizumab in severe asthmatics across ages: A real life Italian experience

Abstract: Background Asthma in the elderly seems to be more severe compared to asthma in younger

Cited by 36 publications

References 48 publications

Short- and long-term real-world effectiveness of omalizumab in severe allergic asthma: systematic review of 42 studies published 2008-2018

Short- and long-term real-world effectiveness of omalizumab in severe allergic asthma: systematic review of 42 studies published 2008-2018

Asthma in the elderly and late‐onset adult asthma

Late-onset asthma: current perspectives

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