RATIONALE: ABPA is associated with deteriorating lung function and is a common complication in asthma patients. Long-term therapy with oral corticosteroids is usually required for repeated exacerbations, resulting in drug toxicity. It has been reported that anti-IgE therapy with omalizumab can be an effective therapy option in ABPA patients.
METHODS: We report 3 asthma patients with ABPA taking prednisone at 20mg/day for patient 1 (M, 45y.o.), 40mg/day for patient 2 (M, 70y.o.), and 20mg/day for patient 3 (F, 31y.o.); also treated with omalizumab 375 mg every 2, 3, and 4 weeks for patient 1, 2, and 3 respectively. Patients were evaluated for steroid reduction, respiratory symptoms, and pulmonary function parameters.
RESULTS: All 3 patients had skin test positivity to A. fumigatus, bronchiectasis, and high IgE levels suggesting ABPA diagnosis. For Patient 1, prednisone was decreased to 10mg/day 3 months after starting omalizumab treatment (OT) and stopped 9 months after. Patient 2 and 3 stopped taking prednisone 12 and 3 months after OT, respectively. All patients reported about 3 ABPA exacerbation per year prior to OT and about 1 exacerbation while on omalizumab. Only patient 1 experienced FEV1 improvement from baseline (2.70l to 3.00l) 3 months after OT. Patients reported significant clinical improvement of respiratory symptoms, decreased exacerbations, and overall improvement in health as early as 3 months after therapy.
CONCLUSIONS: Omalizumab has the potential to be an effective alternative or as an additional therapy option for ABPA in asthma patients who fail to respond to corticosteroids, providing a steroid sparring effect.
Full conference title:
- AAAAI 2019