Question
For the past 4 months, my patient's allergy-induced asthma has been uncontrolled regardless of 1.5 years of immunotherapy, maximum dosages of allergy medications, very high doses of inhaled steroids, and (for the past month) dependence on high doses of oral steroids. Omalizumab is being recommended. How long should I expect this treatment to continue, and would its positive effects continue after discontinuation?
Lauri Carrier, MD
Response from the Expert
William W. Storms, MD
Director, The William Storms Allergy Clinic, Colorado Springs, Colorado; Clinical Professor, University of Colorado Health Sciences Center, Denver, Colorado
The question in regard to omalizumab therapy has not been answered concerning our knowledge of this product. First, I must say that the patient who you have described sounds like a good candidate for omalizumab, especially with the oral steroid use. The precise duration of use has not been determined; however, in terms of efficacy, there should be response with omalizumab within 3-6 months, otherwise treatment should be discontinued. A positive response to treatment should be measured by a reduced use of steroids, both oral and inhaled, as well as measures, such as improved quality of life, improved exercise capacity, and improved sleep patterns. My understanding of the clinical usage of omalizumab has been that many doctors are trying either to reduce the patient's dosage or spread out the dosing interval after the patient has had an excellent response, which has been maintained for about a year.
With our current knowledge of this product, which essentially blocks the effects of immunoglobulin (Ig)E, the fact is that the IgE level may return to pretreatment levels after omalizumab has been discontinued for about 9 months. With these data, one might expect that the patient's asthma would also return after the omalizumab has stopped, but no one has studied this. At the present time, I tell my patients that they should continue taking omalizumab, and physicians should try to reduce their dosages or dosing intervals over time.