Omalizumab Effectiveness in Severe Allergic Asthma with Multiple Allergic Comorbidities: A Post-Hoc Analysis of the STELLAIR Study

Abstract

Jocelyne Just,1– 3 Celine Thonnelier,4 Melisande Bourgoin-Heck,5 Laurence Mala,4 Mathieu Molimard,6 Marc Humbert7– 9 On behalf of the STELLAIR Investigators1Groupe Hospitalier Trousseau-La Roche Guyon, Service d’Allergologie, Paris, France; 2Université Paris Sorbonne, Paris, France; 3UMR 1153 - Centre de Recherche en Épidémiologie et Statistiques (CRESS), Paris, France; 4Novartis Pharma, Rueil Malmaison, France; 5Hôpital Trousseau, Service d’Allergologie, Paris, France; 6CHU de Bordeaux, Service de Pharmacologie Médicale, Bordeaux, France; 7Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France; 8AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; 9INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, FranceCorrespondence: Jocelyne JustService d’Allergologie, Groupe hospitalier Trousseau-La Roche Guyon, 26 Avenue du Dr. Arnold Netter, Paris, 75012, FranceTel [phone]Fax [phone]Email [email protected]: Immunoglobulin (Ig) E-mediated pathophysiological mechanisms are common in allergic diseases including severe allergic asthma (SAA). The anti-IgE monoclonal antibody omalizumab may be particularly beneficial for patients with SAA and multiple allergic comorbidities (AC) including perennial/seasonal rhinitis, conjunctivitis, atopic dermatitis (AD), and food allergy.Methods: We conducted a post-hoc analysis of the patients from the STELLAIR study (n=872, 149 minors and 723 adults). The patients were classified based on the presence of multiple AC (≥ 3 AC or < 3 AC) or AD as assessed by questionnaire. Response to omalizumab was assessed after 4– 6 months (T4– 6) and after 12 months (T12). Asthma response at T4– 6 was based on global evaluation of treatment effectiveness, reduction of ≥ 40% in annual exacerbation rate, and a combination of both. Asthma response at T12 was based on change in yearly exacerbation and hospitalization rates. AC improvement at T12 was based on patient perception.Results: Patients with ≥ 3 AC demonstrated a higher combined response to omalizumab (74.7% vs 58.3%) at T4– 6 and had reduced yearly exacerbation and hospitalization rates (88.9% vs 77.4% and − 94.0% vs − 70.5%, respectively). Patients with ≥ 3 AC were more likely to show an improvement in their AC (85.3% vs 51.9%) at T12. Results were similar in minors and adults. The presence of AD was associated with greater omalizumab effectiveness at T4– 6 and a greater AC improvement at T12. Improvement of AD and food allergies at T12 were 73.2% and 38.7%, respectively, in the population overall.Conclusion: This post-hoc analysis of the STELLAIR study shows that omalizumab is beneficial for all SAA patients and especially for patients with multiple AC or AD. In patients with ≥ 3 AC, omalizumab also improved AC outcomes.Keywords: Ig-E, multiple allergic comorbidities, omalizumab, severe allergic asthma

Keywords

• ig-e
• multiple allergic comorbidities
• omalizumab
• severe allergic asthma