Factors reducing omalizumab response in severe asthma

6533b851fe1ef96bd12a905a

RESEARCH PRODUCT

Factors reducing omalizumab response in severe asthma

Manuela Latorre Andrea Matucci Marco Scalese Pierachille Santus Bruno Sposato Alberto Cresti Simonetta Masieri Nicola Scichilone Manlio Milanese Pierluigi Paggiaro Alessandra Vultaggio Carlo Cavaliere Alberto Ricci Antonio Perrella

subject

Male Severe asthma Drug Resistance Comorbidity Omalizumab Omalizumab Adrenal Cortex Hormone Comorbidities 0302 clinical medicine Retrospective Studie Adrenal Cortex Hormones Risk Factors Forced Expiratory Volume Age Factor Nasal polyps Anti-Asthmatic Agents 030212 general & internal medicine Multivariate Analysi Smoking Age Factors Real-life Middle Aged Treatment Outcome Italy Female Comorbiditie Human medicine.drug Adult age; comorbidities; obesity; omalizumab; real-life; severe asthma; therapeutic response; internal medicine medicine.medical_specialty Logistic Model Therapeutic response Settore MED/10 - Malattie Dell'Apparato Respiratorio Nitric Oxide 03 medical and health sciences FEV1/FVC ratio Nasal Polyps Age Internal medicine Internal Medicine medicine Anti-Asthmatic Agent Humans Obesity Risk factor Retrospective Studies Asthma business.industry Risk Factor medicine.disease Comorbidity Asthma respiratory tract diseases Logistic Models 030228 respiratory system Concomitant Multivariate Analysis Exhaled nitric oxide Nasal Polyp Age; Comorbidities; Obesity; Omalizumab; Real-life; Severe asthma; Therapeutic response business

description

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. 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, were considered as a response to Omalizumab. Results: Age was an independent risk factor for a reduced response concerning FEV1%, 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 FEV1 (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.

year	journal	country	edition	language
2018-01-01	European Journal of Internal Medicine

https://doi.org/10.1016/j.ejim.2018.01.026