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.
Factors reducing omalizumab response in severe asthma / B. Sposato, M. Scalese, M. Milanese, S. Masieri, C. Cavaliere, M. Latorre, N. Scichilone, A. Matucci, A. Vultaggio, A. Ricci, A. Cresti, P. Santus, A. Perrella, P.L. Paggiaro. - In: EUROPEAN JOURNAL OF INTERNAL MEDICINE. - ISSN 0953-6205. - 52(2018 Jun), pp. 78-85.
|Titolo:||Factors reducing omalizumab response in severe asthma|
|Parole Chiave:||Age; Comorbidities; Obesity; Omalizumab; Real-life; Severe asthma; Therapeutic response; Adrenal Cortex Hormones; Adult; Age Factors; Anti-Asthmatic Agents; Asthma; Comorbidity; Drug Resistance; Female; Forced Expiratory Volume; Humans; Italy; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nasal Polyps; Nitric Oxide; Obesity; Omalizumab; Retrospective Studies; Risk Factors; Smoking; Treatment Outcome; Internal Medicine|
|Settore Scientifico Disciplinare:||Settore MED/10 - Malattie dell'Apparato Respiratorio|
Settore MED/09 - Medicina Interna
|Data di pubblicazione:||giu-2018|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.ejim.2018.01.026|
|Appare nelle tipologie:||01 - Articolo su periodico|