Effects of omalizumab in allergic bronchopulmonary aspergillosis in 10 asthmatic patients

Background. - The treatment of allergic bronchopulmonary aspergillosis (ABPA) consists of oral corticosteroids but adverse effects commonly occur. Case reports have reported the efficacy of omalizumab (a monoclonal IgE antibody), particularly due to its steroid-sparing effect. Aim. - To evaluate the effects of omalizumab in patients with ABPA at the Pneumology Department of Strasbourg University Hospital. Patients and methods. - This was a single-centre retrospective study. Data were collected at 6 and 12 months after the start of treatment. The efficacy of omalizumab was assessed in terms of asthma control according to GINA 2018, annualized rate of severe exacerbations, medications used and pulmonary function. Results. - Ten patients were included. At baseline, the median annualized rate of exacerbations was 5.5 [0-13]. After 6 months of treatment, the median annualized rate of exacerbations was 2 [0-14], with systemic corticosteroids being stopped in 5/8 (62.5%) of patients and asthma control being attained in 5/10 (50%). However, between the 6th and 12th months, 60% of patients stopped omalizumab due to lack of asthma control. Among the 40% of patients continuing treatment with omalizumab beyond 12 months, asthma control was achieved in 100% of cases, the annualized rate of exacerbations was zero, and none of the patients was on systemic corticosteroids at 6 and 12 months. Conclusion. - Omalizumab resulted in a steroid-sparing effect in ABPA, with a reduction in severe exacerbations and oral corticosteroid use. (C) 2019 Elsevier Masson SAS. All rights reserved.