Background While asthma is a chronic inflammatory disorder that is managed with inhaled controller and reliever drugs, there remains a large unmet need at the severe end of the disease spectrum.
Omalizumab is licenced as add-on therapy for patients with uncontrolled severe persistent atopic (IgE-mediated) asthma.
Aim Retrospective review of healthcare utilisation and clinical outcomes of the efficacy of Omalizumab administered as per NICE approval on a 2- or 4-weekly basis in adults with severe allergic asthma in our tertiary centre in Hull.
Methods We compared data in our cohort of patients on Omalizumab therapy at 2-years pre-Omalizumab, 16-weeks, 1- and 2-years post-Omalizumab. Our primary outcome was healthcare utilisation (asthma-related hospital admissions, bed and critical care bed days, oral corticosteroid courses (OCS) and reduction in overall OCS dose). Secondary parameters assessed included subjective (asthma control test (ACT), and quality-of-life (AQLQ) and its domain scores) and objective parameters (spirometry and morning peak flows) outcomes.
Results Our 9 patients (2 M, 7 F) on Omalizumab therapy had an average (±SD) age of 52 (±11.9) Overall in-hospital admissions reduced from 28 days in the 2 years pre-Omalizumab to 0, 4 and 3 days at 16-weeks, 1- and 2-years respectively. Correspondingly, medical bed days diminished from 163 pre-treatment to 0, 17 and 10 at 16-weeks, 1- and 2-years respectively. Astonishingly, critical care bed day’s utility declined from 36 pre-Omalizumab, to 0 at all post-Omalizumab time points. Furthermore, total OCS courses usage reduced noticeably from 39 pre-treatment to 5, 9 and 10 at 16-weeks, 1- and 2-years respectively. There were marked improvements in AQLQ and its domains, and ACT scores, however changes in objective measures assessed were minimal (see Table 1).
Conclusion Results from our single centre, in a small cohort of severe atopic asthmatics treated with Omalizumab, have shown striking reductions in healthcare resource utilisation, OCS use and subjective assessments compared to the two years prior to its initiation. This real-life effectiveness of Omalizumab supports its utility in this group of severely allergic asthmatics refractory to standard treatment.