Omalizumab Treatment for Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis

Emiralioğlu, Nagehan; Doğru, Deniz; Tuğcu, Gökçen Dilşa; Yalçın, Ebru; Ki̇per, Nural; Özçeli̇k, Uğur

doi:10.1177/1060028015624204

Cited by 28 publications

(17 citation statements)

References 16 publications

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“…In CF patients, previous studies have shown inconsistent results regarding predictors of response. Notably, in one case series [ 23 ], patients with severe initial disease did not improve FEV1pp on omalizumab whereas in another article omalizumab was less effective in patients with severe lung disease and long-term ABPA [ 24 ]. In our study, no significant correlations were observed between the levels of IgE before omalizumab initiation and the change in FEV 1 pp max value, the slope or the AUC while on omalizumab.…”

Section: Discussioncontrasting

confidence: 69%

Omalizumab for asthma and allergic bronchopulmonary aspergillosis in adults with cystic fibrosis

Koutsokera

Corriveau

Sykes

et al. 2020

Journal of Cystic Fibrosis

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Background: In cystic fibrosis (CF), omalizumab has been used for difficult-to-treat asthma and allergic bronchopulmonary aspergillosis (ABPA) but safety and efficacy data are limited for this population. Methods: We assessed patients receiving omalizumab for asthma or ABPA in the Toronto adult CF center between 2005 and 2017. We evaluated treatment safety and efficacy by analyzing changes in FEV 1 % predicted (FEV 1 pp) max value, slope and variability captured by the area under the curve (AUC), the cumulative dose of systemic corticosteroids (SCS), use of intravenous (IV) antibiotics and hospitalization days before omalizumab and up to 1 year after treatment initiation. Linear mixed effects model was used for FEV 1 pp slope and the trapezoidal rule for FEV 1 pp AUC. Results: Twenty-seven CF patients received omalizumab, 16 (59.3%) for asthma and 11 (40.7%) for ABPA. No significant omalizumab-related adverse effects were observed. In the asthmatic group, the max value of FEV 1 pp improved on omalizumab and the cumulative dose of SCS decreased. In the ABPA group, the rate of FEV 1 pp decline (slope) and the variability of FEV 1 pp (AUC) improved on omalizumab. In ABPA patients, the cumulative SCS dose was not significantly different but 4 (36%) patients decreased their SCS dose by > 50% compared to baseline. Days on IV antibiotics and hospital days did not differ significantly before and while on omalizumab therapy. Conclusions: In adult CF patients with difficult-to-treat asthma or ABPA, omalizumab should be considered. Larger studies are needed to identify patient characteristics that may predict response to omalizumab.

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Section: Discussioncontrasting

confidence: 69%

Omalizumab for asthma and allergic bronchopulmonary aspergillosis in adults with cystic fibrosis

Koutsokera

Corriveau

Sykes

et al. 2020

Journal of Cystic Fibrosis

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“…There is recent evidence that treatment with omalizumab can decrease the risk of recurrent exacerbations. This argues for IgE's central role in the pathology of the disease process (10,11). Although a number of molds have been implicated as causes of ABPM, Aspergillus species are by far the most common -of which A. fumigatus is seen most commonly (12).…”

Section: Introductionmentioning

confidence: 99%

Human IgE mAbs define variability in commercial Aspergillus extract allergen composition

Wurth¹,

Hadadianpour²,

Horvath³

et al. 2018

JCI Insight

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“…Omalizumab (300 mg dosage) was administered subcutaneously every 4 weeks to the patients who were treated previously with oral prednisolone and itraconazole. Decreased IgE levels, improvement in respiratory symptoms, and a steroidsparing effect was shown with omalizumab treatment (118). A retrospective multicenter observational French study retrieved 32 patients with ABPA and CF (11 children and 21 adults) who had received omalizumab for more than 3 months.…”

Section: Omalizumabmentioning

confidence: 99%

Current Approach in the Diagnosis and Management of Allergic Bronchopulmonary Aspergillosis in Children With Cystic Fibrosis

et al. 2020

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Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disorder characterized by a hypersensitivity reaction to Aspergillus fumigatus, and almost always seen in patients with cystic fibrosis (CF) and asthma. Fungal hyphae leads to an ongoing inflammation in the airways that may result in bronchiectasis, fibrosis, and eventually loss of lung function. Despite the fact that ABPA is thought to be more prevalent in CF than in asthma, the literature on ABPA in CF is more limited. The diagnosis is challenging and may be delayed because it is made based on a combination of clinical features, and radiologic and immunologic findings. With clinical deterioration of a patient with CF, ABPA is important to be kept in mind because clinical manifestations mimic pulmonary exacerbations of CF. Early diagnosis and appropriate treatment are important in preventing complications related to ABPA. Treatment modalities involve the use of anti-inflammatory agents to suppress the immune hyperreactivity and the use of antifungal agents to reduce fungal burden. Recently, in an effort to treat refractory patients or to reduce adverse effects of steroids, other treatment options such as monoclonal antibodies have started to be used. Intensive research of these new agents in the treatment of children is being conducted to address insufficient data.

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Omalizumab Treatment for Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis

Cited by 28 publications

References 16 publications

Omalizumab for asthma and allergic bronchopulmonary aspergillosis in adults with cystic fibrosis

Omalizumab for asthma and allergic bronchopulmonary aspergillosis in adults with cystic fibrosis

Human IgE mAbs define variability in commercial Aspergillus extract allergen composition

Current Approach in the Diagnosis and Management of Allergic Bronchopulmonary Aspergillosis in Children With Cystic Fibrosis

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