Clinical efficacy and immunologic effects of omalizumab in allergic bronchopulmonary aspergillosis

AL Voskamp, A Gillman, K Symons, A Sandrini… - The Journal of Allergy …, 2015 - Elsevier
AL Voskamp, A Gillman, K Symons, A Sandrini, JM Rolland, RE O'Hehir, JA Douglass
The Journal of Allergy and Clinical Immunology: In Practice, 2015Elsevier
Background Allergic bronchopulmonary aspergillosis (ABPA) often presents with
persistently uncontrolled asthma despite the use of corticosteroids and antifungal therapy.
Omalizumab is a humanized anti-IgE monoclonal antibody currently used to treat severe
asthma. Objective The aim was to assess the clinical and immunologic effects of
omalizumab in ABPA in a randomized, placebo-controlled trial. Methods Patients with
chronic ABPA were randomized to 4-month treatment with omalizumab (750 mg monthly) or …
Background
Allergic bronchopulmonary aspergillosis (ABPA) often presents with persistently uncontrolled asthma despite the use of corticosteroids and antifungal therapy. Omalizumab is a humanized anti-IgE monoclonal antibody currently used to treat severe asthma.
Objective
The aim was to assess the clinical and immunologic effects of omalizumab in ABPA in a randomized, placebo-controlled trial.
Methods
Patients with chronic ABPA were randomized to 4-month treatment with omalizumab (750 mg monthly) or placebo followed by a 3-month washout period in a cross-over design. The main endpoint was number of exacerbations. Other clinical endpoints included lung function, exhaled nitric oxide (FeNO), quality of life and symptoms. In vitro basophil activation to Aspergillus fumigatus extract and basophil FcεR1 and surface-bound IgE levels were assessed by flow cytometry.
Results
Thirteen patients were recruited with mean total IgE 2314 ± 2125 IU/mL. Exacerbations occurred less frequently during the active treatment phase compared with the placebo period (2 vs 12 events, P = .048). Mean FeNO decreased from 30.5 to 17.1 ppb during omalizumab treatment (P = .03). Basophil sensitivity to A. fumigatus and surface-bound IgE and FcεR1 levels decreased significantly after omalizumab but not after placebo.
Conclusion
Omalizumab can be used safely to treat ABPA, despite high serum IgE levels. Clinical improvement was accompanied by decreased basophil reactivity to A. fumigatus and FcεR1 and surface-bound IgE levels.
Elsevier