Steroid dependency despite omalizumab treatment of ABPA in cystic fibrosis

Brinkmann, Folke; Schwerk, Nicolaus; Hansen, G.; Ballmann, Manfred

doi:10.1111/j.1398-9995.2009.02147.x

Cited by 39 publications

(30 citation statements)

References 6 publications

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“…In particular, omalizumab failed in a CF patient with ABPA for 4 years when treatment was started. After an initial response ABPA worsened under attempts to reduce systemic steroids [Brinkmann et al 2010]. This is in concordance with what we found in this long-term observation.…”

Section: Discussionsupporting

confidence: 92%

Omalizumab: a new treatment option for allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Lehmann

Pfannenstiel²,

Friedrichs³

et al. 2014

Ther Adv Respir Dis

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Section: Discussionsupporting

confidence: 92%

Omalizumab: a new treatment option for allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Lehmann

Pfannenstiel²,

Friedrichs³

et al. 2014

Ther Adv Respir Dis

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“…In a metaanalysis of 14 trials (n=3,143 asthmatics), the use of omalizumab was shown to decrease the requirement of ICS and reduce the number of exacerbations [86]. Omalizumab also has been shown to be beneficial in ABPA [87][88][89][90][91][92][93][94][95] and thus can be expected to benefit patients with SAFS.…”

Section: Anti-ige Therapymentioning

confidence: 99%

Severe Asthma with Fungal Sensitization

Agarwal

2011

Curr Allergy Asthma Rep

154

107

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A new phenotype of asthma has been described recently, namely severe asthma with fungal sensitization (SAFS). SAFS can be conceptualized as a continuum of fungal sensitization, with asthma at one end and allergic bronchopulmonary aspergillosis at the other. It is diagnosed by the presence of severe asthma, fungal sensitization, and exclusion of allergic bronchopulmonary aspergillosis. Because of the paucity of data and ambiguity in diagnostic criteria, SAFS is currently more of a diagnosis of exclusion than a specific entity. Treatment of SAFS initially should be similar to that of severe asthma, including the use of omalizumab. The potential role of itraconazole as a specific therapy in SAFS requires more evidence before it can be incorporated in routine practice. An urgent need exists for data regarding the prevalence, natural history, and clinical relevance of SAFS so that its exact characterization and importance as a specific subtype of asthma can be clearly defined. This review summarizes the current understanding of the pathogenesis, diagnosis, and management of SAFS.

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“…However, because of the toxicity of prolonged systemic glucocorticosteroid therapy and often inadequate control of ABPA with combination steroid‐azole therapy, omalizumab is increasingly used in treatment of ABPA 51 . To date 64 omalizumab‐treated ABPA patients have been reported in abstracts and peer reviewed publications, with reduced exacerbations and systemic steroid burden being the main benefits of therapy 52–60 . However, no placebo‐controlled trials have been completed.…”

Section: Anti‐igementioning

confidence: 99%

The use of biological agents for the treatment of fungal asthma and allergic bronchopulmonary aspergillosis

Moss

2012

Annals of the New York Academy of Sciences

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Allergic bronchopulmonary aspergillosis (ABPA) is a virulent manifestation of the Th2 asthma endotype that includes asthma with fungal sensitization, raising the feasibility of biological therapies targeting Th2 pathway molecules or cells. The first molecule amenable to clinical intervention with a biological was IgE. Omalizumab, a humanized monoclonal antibody (Mab), targets the same epitope on the IgE CH3 region that binds to and crosslinks high-affinity receptors on mast cells and basophils, thereby initiating the allergic inflammatory cascade. Omalizumab is licensed for allergic asthma and has been beneficial in uncontrolled studies of ABPA, reducing exacerbations and steroid requirements. Trials of several Mabs directed against the Th2 cytokine IL-5 show clinical benefit in patients with a severe refractory eosinophilic asthma phenotype, while a Mab against IL-13 is effective in asthma patients with a Th2-high endotype. Immunodulation is also feasible with small molecule biologicals, such as antisense oligodeoxynucleotides and cholecalciferol. Controlled trials of Th2-inhibiting biologicals in patients with ABPA and severe asthma with fungal sensitization appear warranted.

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Steroid dependency despite omalizumab treatment of ABPA in cystic fibrosis

Cited by 39 publications

References 6 publications

Omalizumab: a new treatment option for allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Omalizumab: a new treatment option for allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Severe Asthma with Fungal Sensitization

The use of biological agents for the treatment of fungal asthma and allergic bronchopulmonary aspergillosis

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