Advertisement

Treatment with Anti-IgE Monoclonal Antibody and Free IgE

  • Hisako MatsumotoEmail author
Chapter
Part of the Respiratory Disease Series: Diagnostic Tools and Disease Managements book series (RDSDTDM)

Abstract

Treatment with omalizumab, a monoclonal anti-IgE antibody, significantly reduces asthma symptoms, frequency of reliever use, and severe asthma exacerbations while improving pulmonary function in patients with severe allergic asthma who experience inadequate control with high doses of inhaled corticosteroids and other controllers. Airway tissue measurements and computed tomography have also shown that omalizumab treatment improves airway remodeling. In addition, omalizumab may augment protective effects against rhinovirus infection by potentially improving type I interferon production. Comorbidities related to severe asthma, such as eosinophilic chronic rhinosinusitis, allergic bronchopulmonary aspergillosis, and aspirin-exacerbated respiratory diseases, also respond to omalizumab treatment. Thus, omalizumab has introduced a new era for the management of severe asthma. However, given the heterogeneous nature of severe asthma, responses to omalizumab vary in patients with severe allergic asthma. Better responses to omalizumab are expected in patients with type 2-high inflammation who show higher levels of exhaled nitric oxide, blood eosinophils, and serum periostin. Lastly, the optimal duration of omalizumab treatment remains unknown, though discontinuation of omalizumab after a 5-year treatment period yielded significantly worse outcomes for asthma control than continuation thereof. Subsequently, higher blood eosinophil counts have been suggested to predict failure after treatment discontinuation.

Keywords

Omalizumab Type 2 inflammation Free IgE 

References

  1. 1.
    Gould HJ, Sutton BJ. IgE in allergy and asthma today. Nat Rev Immunol. 2008;8:205–17.CrossRefGoogle Scholar
  2. 2.
    Lowe PJ, Renard D. Omalizumab decreases IgE production in patients with allergic (IgE-mediated) asthma; PKPD analysis of a biomarker, total IgE. Br J Clin Pharmacol. 2011;72:306–20.CrossRefGoogle Scholar
  3. 3.
    Djukanovic R, Wilson SJ, Kraft M, Jarjour NN, Steel M, Chung KF, et al. Effects of treatment with anti-immunoglobulin E antibody omalizumab on airway inflammation in allergic asthma. Am J Respir Crit Care Med. 2004;170:583–93.CrossRefGoogle Scholar
  4. 4.
    Pillai P, Chan YC, Wu SY, Ohm-Laursen L, Thomas C, Durham SR, et al. Omalizumab reduces bronchial mucosal IgE and improves lung function in non-atopic asthma. Eur Respir J. 2016;48:1593–601.CrossRefGoogle Scholar
  5. 5.
    Beck LA, Marcotte GV, MacGlashan D, Togias A, Saini S. Omalizumab-induced reductions in mast cell Fce psilon RI expression and function. J Allergy Clin Immunol. 2004;114:527–30.CrossRefGoogle Scholar
  6. 6.
    Hanf G, Brachmann I, Kleine-Tebbe J, Seybold J, Kunkel G, Suttorp N, et al. Omalizumab decreased IgE-release and induced changes in cellular immunity in patients with allergic asthma. Allergy. 2006;61:1141–4.CrossRefGoogle Scholar
  7. 7.
    Chan MA, Gigliotti NM, Dotson AL, Rosenwasser LJ. Omalizumab may decrease IgE synthesis by targeting membrane IgE+ human B cells. Clin Transl Allergy. 2013;3:29.CrossRefGoogle Scholar
  8. 8.
    Busse W, Corren J, Lanier BQ, McAlary M, Fowler-Taylor A, Cioppa GD, et al. Omalizumab, anti-IgE recombinant humanized monoclonal antibody, for the treatment of severe allergic asthma. J Allergy Clin Immunol. 2001;108:184–90.CrossRefGoogle Scholar
  9. 9.
    Rodrigo GJ, Neffen H, Castro-Rodriguez JA. Efficacy and safety of subcutaneous omalizumab vs placebo as add-on therapy to corticosteroids for children and adults with asthma: a systematic review. Chest. 2011;139:28–35.CrossRefGoogle Scholar
  10. 10.
    Ohta K, Miyamoto T, Amagasaki T, Yamamoto M. Efficacy and safety of omalizumab in an Asian population with moderate-to-severe persistent asthma. Respirology. 2009;14:1156–65.CrossRefGoogle Scholar
  11. 11.
    Alhossan A, Lee CS, MacDonald K, Abraham I. “Real-life” effectiveness studies of omalizumab in adult patients with severe allergic asthma: meta-analysis. J Allergy Clin Immunol Pract. 2017;5:1362–70.e2.CrossRefGoogle Scholar
  12. 12.
    Mauri P, Riccio AM, Rossi R, Di Silvestre D, Benazzi L, De Ferrari L, et al. Proteomics of bronchial biopsies: galectin-3 as a predictive biomarker of airway remodelling modulation in omalizumab-treated severe asthma patients. Immunol Lett. 2014;162:2–10.CrossRefGoogle Scholar
  13. 13.
    Hoshino M, Ohtawa J. Effects of adding omalizumab, an anti-immunoglobulin E antibody, on airway wall thickening in asthma. Respiration. 2011;83:520–8.CrossRefGoogle Scholar
  14. 14.
    Tajiri T, Niimi A, Matsumoto H, Ito I, Oguma T, Otsuka K, et al. Comprehensive efficacy of omalizumab for severe refractory asthma: a time-series observational study. Ann Allergy Asthma Immunol. 2014;113:470–5.e2.CrossRefGoogle Scholar
  15. 15.
    Teach SJ, Gill MA, Togias A, Sorkness CA, Arbes SJ Jr, Calatroni A, et al. Preseasonal treatment with either omalizumab or an inhaled corticosteroid boost to prevent fall asthma exacerbations. J Allergy Clin Immunol. 2015;136:1476–85.CrossRefGoogle Scholar
  16. 16.
    Hanania NA, Wenzel S, Rosen K, Hsieh HJ, Mosesova S, Choy DF, et al. Exploring the effects of omalizumab in allergic asthma: an analysis of biomarkers in the EXTRA study. Am J Respir Crit Care Med. 2013;187:804–11.CrossRefGoogle Scholar
  17. 17.
    Tajiri T, Matsumoto H, Gon Y, Ito R, Hashimoto S, Izuhara K, et al. Utility of serum periostin and free IgE levels in evaluating responsiveness to omalizumab in patients with severe asthma. Allergy. 2016;71(10):1472–9.CrossRefGoogle Scholar
  18. 18.
    Casale TB, Chipps BE, Rosen K, Trzaskoma B, Haselkorn T, Omachi TA, et al. Response to omalizumab using patient enrichment criteria from trials of novel biologics in asthma. Allergy. 2017;73:490–7.CrossRefGoogle Scholar
  19. 19.
    Slavin RG, Ferioli C, Tannenbaum SJ, Martin C, Blogg M, Lowe PJ. Asthma symptom re-emergence after omalizumab withdrawal correlates well with increasing IgE and decreasing pharmacokinetic concentrations. J Allergy Clin Immunol. 2009;123:107–13.e3.CrossRefGoogle Scholar
  20. 20.
    Ito R, Gon Y, Nunomura S, Atsuta R, Harada N, Hattori T, et al. Development of assay for determining free IgE levels in serum from patients treated with omalizumab. Allergol Int. 2014;63(Suppl 1):37–47.CrossRefGoogle Scholar
  21. 21.
    Gon Y, Ito R, Maruoka S, Mizumura K, Kozu Y, Hiranuma H, et al. Long-term course of serum total and free IgE levels in severe asthma patients treated with omalizumab. Allergol Int. 2018;67(2):283–5.CrossRefGoogle Scholar
  22. 22.
    Gevaert P, Calus L, Van Zele T, Blomme K, De Ruyck N, Bauters W, et al. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. J Allergy Clin Immunol. 2013;131:110–6.e1.CrossRefGoogle Scholar
  23. 23.
    Tajiri T, Matsumoto H, Hiraumi H, Ikeda H, Morita K, Izuhara K, et al. Efficacy of omalizumab in eosinophilic chronic rhinosinusitis patients with asthma. Ann Allergy Asthma Immunol. 2013;110:387–8.CrossRefGoogle Scholar
  24. 24.
    Hayashi H, Mitsui C, Nakatani E, Fukutomi Y, Kajiwara K, Watai K, et al. Omalizumab reduces cysteinyl leukotriene and 9alpha,11beta-prostaglandin F2 overproduction in aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2015;137:1585–7.e4.CrossRefGoogle Scholar
  25. 25.
    Tillie-Leblond I, Germaud P, Leroyer C, Tetu L, Girard F, Devouassoux G, et al. Allergic bronchopulmonary aspergillosis and omalizumab. Allergy. 2011;66:1254–6.CrossRefGoogle Scholar
  26. 26.
    Voskamp AL, Gillman A, Symons K, Sandrini A, Rolland JM, O’Hehir RE, et al. Clinical efficacy and immunologic effects of omalizumab in allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract. 2015;3:192–9.CrossRefGoogle Scholar
  27. 27.
    Maltby S, Gibson PG, Powell H, McDonald VM. Omalizumab treatment response in a population with severe allergic asthma and overlapping COPD. Chest. 2017;151:78–89.CrossRefGoogle Scholar
  28. 28.
    Novelli F, Latorre M, Vergura L, Caiaffa MF, Camiciottoli G, Guarnieri G, et al. Asthma control in severe asthmatics under treatment with omalizumab: a cross-sectional observational study in Italy. Pulm Pharmacol Ther. 2015;31:123–9.CrossRefGoogle Scholar
  29. 29.
    Sposato B, Scalese M, Latorre M, Novelli F, Scichilone N, Milanese M, et al. Can the response to Omalizumab be influenced by treatment duration? A real-life study. Pulm Pharmacol Ther. 2017;44:38–45.CrossRefGoogle Scholar
  30. 30.
    Molimard M, Mala L, Bourdeix I, Le Gros V. Observational study in severe asthmatic patients after discontinuation of omalizumab for good asthma control. Respir Med. 2014;108:571–6.CrossRefGoogle Scholar
  31. 31.
    Nopp A, Johansson SG, Adedoyin J, Ankerst J, Palmqvist M, Oman H. After 6 years with Xolair; a 3-year withdrawal follow-up. Allergy. 2010;65:56–60.CrossRefGoogle Scholar
  32. 32.
    Kuprys-Lipinska I, Kuna P. Loss of asthma control after cessation of omalizumab treatment: real life data. Postepy Dermatol Alergol. 2014;31:1–5.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Ledford D, Busse W, Trzaskoma B, Omachi TA, Rosen K, Chipps BE, et al. A randomized multicenter study evaluating Xolair persistence of response after long-term therapy. J Allergy Clin Immunol. 2017;140:162–9.e2.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Respiratory MedicineKyoto University of Graduate School of Medicine, Kyoto UniversityKyoto CityJapan

Personalised recommendations