Sposato B, et al. - The purpose of this analysis was to explore the potential factors exerting an influence on a reduced omalizumab response in a large cohort of severe asthmatics in terms of disease control. A possible reduction could be noted in the omalizumab effectiveness due to age, obesity, comorbidities, smoking habits, nasal polyps, allergic poly-sensitization, independent of other asthma-influencing factors.

Methods

• Experts enrolled 340 candidates who were retrospectively analyzed.
• The parameters regarded as a response to omalizumab were FEV1%, 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.

Results

• For a reduced response concerning FEV1%, FVC%, ACT and for a lower asthma control, age was revealed to be an independent risk factor.
• It was reported that 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.
• A reduction was brought about in the response in FEV1 (β = -6.981, p=0.04), FVC (β = -11.689, p=0.014) and ACT (β = -2.585, p=0.027) due to obesity.
• Additionally, it correlated with a higher FENO level (β = 49.045, p=0.040).
• The presence of at least one comorbidity served as 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).
• Data shed light on the connection between chronic heart disease with both a lower ACT and FVC%.
• In contrast, gastroesophageal reflux correlated with a partial/no asthma control.
• It was observed that nasal polyps served as a predisposing factor, giving rise to exacerbations and to the use of higher inhaled corticosteroids doses.
• Smoking habits, pollen or dog/cat dander co-sensitizations possibly exerted a negative impact on the omalizumab response.