Factors reducing omalizumab response in severe asthma.

Autor: Sposato B; Pneumology Department, Misericordia Hospital, Grosseto, Italy. Electronic address: bruno.sposato@uslsudest.toscana.it., Scalese M; Institute of Clinical Phisiology, CNR, Pisa, Italy., Milanese M; Pneumology Department, S.Corona Hospital, Pietra Ligure, Italy., Masieri S; Otorhinolaryngology Clinic, Policlinico Umberto I, 'Sapienza' University, Roma, Italy., Cavaliere C; Otorhinolaryngology Clinic, Policlinico Umberto I, 'Sapienza' University, Roma, Italy., Latorre M; Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy., Scichilone N; DIMPEFINU, Unit of Pneumology and Medicine, University of Palermo, Italy., Matucci A; Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy., Vultaggio A; Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy., Ricci A; Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy., Cresti A; Cardiology Department, Misericordia Hospital, Grosseto, Italy., Santus P; Department of Biomedical And Clinical Sciences (DIBIC), University of Milan, Respiratory Unit, 'Luigi Sacco' University Hospital; ASST Fatebenefratelli-Sacco, Milan, Italy., Perrella A; Pneumology Department, Misericordia Hospital, Grosseto, Italy., Paggiaro PL; Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy.
Jazyk: angličtina
Zdroj: European journal of internal medicine [Eur J Intern Med] 2018 Jun; Vol. 52, pp. 78-85. Date of Electronic Publication: 2018 Feb 01.
DOI: 10.1016/j.ejim.2018.01.026
Abstrakt: Background: Despite adding Omalizumab to conventional therapy, several severe asthmatics still show poor disease control. We investigated the factors that may affect a reduced Omalizumab response in a large population of severe asthmatics.
Methods: 340 patients were retrospectively evaluated. FEV 1 %, FVC%, Asthma Control Test (ACT), fractional exhaled nitric oxide (FENO), possible step-downs/step-ups of concomitant therapies, exacerbations, disease control levels, ICS doses and SABA use, observed at the end of treatment, were considered as a response to Omalizumab.
Results: Age was an independent risk factor for a reduced response concerning FEV 1 %, FVC%, ACT and for a lower asthma control. Obesity (vs normal weight) was a determinant condition for exacerbations (OR:3.114[1.509-6.424], p = 0.002), for a disease partial/no control (OR:2.665[1.064-6.680], p = 0.036), for excessive SABA use (OR:4.448[1.837-10.768], p = 0.002) and for an unchanged/increased level of concomitant asthma medications. Furthermore, obesity also reduced the response in FEV 1 (β = -6.981,p = 0.04), FVC (β = -11.689,p = 0.014) and ACT (β = -2.585, p = 0.027) and was associated with a higher FENO level (β = 49.045,p = 0.040). Having at least one comorbidity was a risk factor for exacerbations (OR:1.383[1.128-1.697], p = 0.008) and for an ACT <20 (OR:2.410[1.071-3.690], p = 0.008). Specifically, chronic heart disease was associated with both a lower ACT and FVC% whereas gastroesophageal reflux with a partial/no asthma control. Nasal polyps were a predisposing factor leading both to exacerbations and to the use of higher inhaled corticosteroids doses. Moreover, smoking habits, pollen or dog/cat dander co-sensitizations may negatively influence Omalizumab response.
Conclusion: Age, obesity, comorbidities, smoking habits, nasal polyps, allergic poly-sensitization might reduce Omalizumab effectiveness independently to other asthma-influencing factors.
(Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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