Case series of omalizumab for allergic bronchopulmonary aspergillosis in cystic fibrosis patients
Summary Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first‐line therapy, but relapse and adverse effects commonly occur. Case reports have suggested the efficacy of the anti‐IgE recombinant humanized monoclonal an...
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| Published in: | Pediatric pulmonology Vol. 52; no. 2; pp. 190 - 197 |
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| Main Authors: | , , , , , , , , , , |
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01.02.2017
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| ISSN: | 8755-6863, 1099-0496, 1099-0496 |
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| Abstract | Summary
Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first‐line therapy, but relapse and adverse effects commonly occur. Case reports have suggested the efficacy of the anti‐IgE recombinant humanized monoclonal antibody omalizumab. A retrospective multicenter observational French study retrieved 32 CF patients (11 children and 21 adults) who have received omalizumab for more than 3 months in the context of ABPA. Clinical characteristics, concomitant medications (inhaled and oral corticosteroids, antifungal drugs), lung function, body mass index (BMI), and serum IgE were compared at the start and during the first year of omalizumab therapy. Omalizumab‐related adverse effects and costs were also evaluated. No significant difference with omalizumab could be demonstrated with regard to lung function, BMI, or the number of patients receiving oral corticosteroids. At the time of initiation of omalizumab, 56% of patients were receiving oral corticosteroids. Five patients were able to discontinue corticosteroids during follow‐up and nine patients were able to reduce their daily dose. A total of 78% of the patients had received antifungal therapy at the time of the initiation of omalizumab. Treatment tolerance was good (12.5% of patients experienced side effects). The median cost of omalizumab treatment was €3,620 per patient per month. Omalizumab may represent a steroid‐sparing therapy in CF patients with ABPA. A randomized‐controlled trial is urgently required to provide higher level of evidence regarding the efficacy and cost‐effectiveness of omalizumab in CF patients with ABPA. Pediatr Pulmonol. 2017;52:190–197. © 2016 Wiley Periodicals, Inc. |
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| AbstractList | Summary
Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first‐line therapy, but relapse and adverse effects commonly occur. Case reports have suggested the efficacy of the anti‐IgE recombinant humanized monoclonal antibody omalizumab. A retrospective multicenter observational French study retrieved 32 CF patients (11 children and 21 adults) who have received omalizumab for more than 3 months in the context of ABPA. Clinical characteristics, concomitant medications (inhaled and oral corticosteroids, antifungal drugs), lung function, body mass index (BMI), and serum IgE were compared at the start and during the first year of omalizumab therapy. Omalizumab‐related adverse effects and costs were also evaluated. No significant difference with omalizumab could be demonstrated with regard to lung function, BMI, or the number of patients receiving oral corticosteroids. At the time of initiation of omalizumab, 56% of patients were receiving oral corticosteroids. Five patients were able to discontinue corticosteroids during follow‐up and nine patients were able to reduce their daily dose. A total of 78% of the patients had received antifungal therapy at the time of the initiation of omalizumab. Treatment tolerance was good (12.5% of patients experienced side effects). The median cost of omalizumab treatment was €3,620 per patient per month. Omalizumab may represent a steroid‐sparing therapy in CF patients with ABPA. A randomized‐controlled trial is urgently required to provide higher level of evidence regarding the efficacy and cost‐effectiveness of omalizumab in CF patients with ABPA. Pediatr Pulmonol. 2017;52:190–197. © 2016 Wiley Periodicals, Inc. Summary Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first-line therapy, but relapse and adverse effects commonly occur. Case reports have suggested the efficacy of the anti-IgE recombinant humanized monoclonal antibody omalizumab. A retrospective multicenter observational French study retrieved 32 CF patients (11 children and 21 adults) who have received omalizumab for more than 3 months in the context of ABPA. Clinical characteristics, concomitant medications (inhaled and oral corticosteroids, antifungal drugs), lung function, body mass index (BMI), and serum IgE were compared at the start and during the first year of omalizumab therapy. Omalizumab-related adverse effects and costs were also evaluated. No significant difference with omalizumab could be demonstrated with regard to lung function, BMI, or the number of patients receiving oral corticosteroids. At the time of initiation of omalizumab, 56% of patients were receiving oral corticosteroids. Five patients were able to discontinue corticosteroids during follow-up and nine patients were able to reduce their daily dose. A total of 78% of the patients had received antifungal therapy at the time of the initiation of omalizumab. Treatment tolerance was good (12.5% of patients experienced side effects). The median cost of omalizumab treatment was [euro]3,620 per patient per month. Omalizumab may represent a steroid-sparing therapy in CF patients with ABPA. A randomized-controlled trial is urgently required to provide higher level of evidence regarding the efficacy and cost-effectiveness of omalizumab in CF patients with ABPA. Pediatr Pulmonol. 2017;52:190-197. © 2016 Wiley Periodicals, Inc. Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first-line therapy, but relapse and adverse effects commonly occur. Case reports have suggested the efficacy of the anti-IgE recombinant humanized monoclonal antibody omalizumab. A retrospective multicenter observational French study retrieved 32 CF patients (11 children and 21 adults) who have received omalizumab for more than 3 months in the context of ABPA. Clinical characteristics, concomitant medications (inhaled and oral corticosteroids, antifungal drugs), lung function, body mass index (BMI), and serum IgE were compared at the start and during the first year of omalizumab therapy. Omalizumab-related adverse effects and costs were also evaluated. No significant difference with omalizumab could be demonstrated with regard to lung function, BMI, or the number of patients receiving oral corticosteroids. At the time of initiation of omalizumab, 56% of patients were receiving oral corticosteroids. Five patients were able to discontinue corticosteroids during follow-up and nine patients were able to reduce their daily dose. A total of 78% of the patients had received antifungal therapy at the time of the initiation of omalizumab. Treatment tolerance was good (12.5% of patients experienced side effects). The median cost of omalizumab treatment was €3,620 per patient per month. Omalizumab may represent a steroid-sparing therapy in CF patients with ABPA. A randomized-controlled trial is urgently required to provide higher level of evidence regarding the efficacy and cost-effectiveness of omalizumab in CF patients with ABPA. Pediatr Pulmonol. 2017;52:190-197. © 2016 Wiley Periodicals, Inc. Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first-line therapy, but relapse and adverse effects commonly occur. Case reports have suggested the efficacy of the anti-IgE recombinant humanized monoclonal antibody omalizumab. A retrospective multicenter observational French study retrieved 32 CF patients (11 children and 21 adults) who have received omalizumab for more than 3 months in the context of ABPA. Clinical characteristics, concomitant medications (inhaled and oral corticosteroids, antifungal drugs), lung function, body mass index (BMI), and serum IgE were compared at the start and during the first year of omalizumab therapy. Omalizumab-related adverse effects and costs were also evaluated. No significant difference with omalizumab could be demonstrated with regard to lung function, BMI, or the number of patients receiving oral corticosteroids. At the time of initiation of omalizumab, 56% of patients were receiving oral corticosteroids. Five patients were able to discontinue corticosteroids during follow-up and nine patients were able to reduce their daily dose. A total of 78% of the patients had received antifungal therapy at the time of the initiation of omalizumab. Treatment tolerance was good (12.5% of patients experienced side effects). The median cost of omalizumab treatment was €3,620 per patient per month. Omalizumab may represent a steroid-sparing therapy in CF patients with ABPA. A randomized-controlled trial is urgently required to provide higher level of evidence regarding the efficacy and cost-effectiveness of omalizumab in CF patients with ABPA. Pediatr Pulmonol. 2017;52:190-197. © 2016 Wiley Periodicals, Inc.Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first-line therapy, but relapse and adverse effects commonly occur. Case reports have suggested the efficacy of the anti-IgE recombinant humanized monoclonal antibody omalizumab. A retrospective multicenter observational French study retrieved 32 CF patients (11 children and 21 adults) who have received omalizumab for more than 3 months in the context of ABPA. Clinical characteristics, concomitant medications (inhaled and oral corticosteroids, antifungal drugs), lung function, body mass index (BMI), and serum IgE were compared at the start and during the first year of omalizumab therapy. Omalizumab-related adverse effects and costs were also evaluated. No significant difference with omalizumab could be demonstrated with regard to lung function, BMI, or the number of patients receiving oral corticosteroids. At the time of initiation of omalizumab, 56% of patients were receiving oral corticosteroids. Five patients were able to discontinue corticosteroids during follow-up and nine patients were able to reduce their daily dose. A total of 78% of the patients had received antifungal therapy at the time of the initiation of omalizumab. Treatment tolerance was good (12.5% of patients experienced side effects). The median cost of omalizumab treatment was €3,620 per patient per month. Omalizumab may represent a steroid-sparing therapy in CF patients with ABPA. A randomized-controlled trial is urgently required to provide higher level of evidence regarding the efficacy and cost-effectiveness of omalizumab in CF patients with ABPA. Pediatr Pulmonol. 2017;52:190-197. © 2016 Wiley Periodicals, Inc. |
| Author | Hubert, Dominique Auzou, Lila Murris‐Espin, Marlène Burgel, Pierre‐Régis Durieu, Isabelle Nové‐Josserand, Raphaële Grard, Soazic Mammar, Benyebka Reix, Philippe Brémont, François Mely, Laurent |
| Author_xml | – sequence: 1 givenname: Raphaële surname: Nové‐Josserand fullname: Nové‐Josserand, Raphaële email: raphaele.nove-josserand@chu-lyon.fr organization: University Center Hospital Lyon‐Sud – sequence: 2 givenname: Soazic surname: Grard fullname: Grard, Soazic organization: University Center Hospital Lyon‐Sud – sequence: 3 givenname: Lila surname: Auzou fullname: Auzou, Lila organization: Cochin Hospital, AP‐HP – sequence: 4 givenname: Philippe surname: Reix fullname: Reix, Philippe organization: University Center Hospital‐HFME – sequence: 5 givenname: Marlène surname: Murris‐Espin fullname: Murris‐Espin, Marlène organization: Rangueil‐Larrey University Hospital – sequence: 6 givenname: François surname: Brémont fullname: Brémont, François organization: University Center Hospital‐CF Pediatric Center – sequence: 7 givenname: Benyebka surname: Mammar fullname: Mammar, Benyebka organization: Center Hospital‐Pneumology Unit – sequence: 8 givenname: Laurent surname: Mely fullname: Mely, Laurent organization: Hospital Renée Sabran – sequence: 9 givenname: Dominique surname: Hubert fullname: Hubert, Dominique organization: Cochin Hospital, AP‐HP – sequence: 10 givenname: Isabelle surname: Durieu fullname: Durieu, Isabelle organization: University Center Hospital Lyon‐Sud – sequence: 11 givenname: Pierre‐Régis surname: Burgel fullname: Burgel, Pierre‐Régis organization: Sorbonne Paris Cité |
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| Cites_doi | 10.1513/pats.200908-086AL 10.1002/ppul.21002 10.1378/chest.115.2.364 10.1111/j.1398-9995.2009.02147.x 10.3109/13693786.2010.503665 10.1128/AAC.05077-11 10.1016/j.jcf.2005.05.019 10.1080/02770900902849871 10.1034/j.1399-3003.2000.016003464.x 10.1016/j.prrv.2012.11.004 10.1002/ppul.22937 10.1086/376525 10.1002/ppul.20907 10.1136/thoraxjnl-2012-201869 10.1067/mai.2003.1388 10.1111/j.1398-9995.2010.02522.x 10.1111/j.1398-9995.2011.02599.x 10.1007/s40265-013-0085-4 10.1136/thx.2004.035519 10.1002/ppul.20804 10.1177/1753465814547517 |
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| Keywords | corticosteroids Aspergillus fumigatus allergic bronchopulmonary aspergillosis (ABPA) immunoglobulin E IgE cystic fibrosis |
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Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first‐line therapy,... Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first-line therapy, but... Summary Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first-line therapy,... |
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| SubjectTerms | Adolescent Adrenal Cortex Hormones - therapeutic use Adult allergic bronchopulmonary aspergillosis (ABPA) Anti-Allergic Agents - therapeutic use Antifungal Agents - therapeutic use Aspergillosis, Allergic Bronchopulmonary - complications Aspergillosis, Allergic Bronchopulmonary - drug therapy Aspergillosis, Allergic Bronchopulmonary - immunology Aspergillus fumigatus Child corticosteroids cystic fibrosis Cystic Fibrosis - complications Drug Therapy, Combination Female Humans IgE immunoglobulin E Immunoglobulin E - immunology Male Middle Aged Omalizumab - therapeutic use Retrospective Studies Young Adult |
| Title | Case series of omalizumab for allergic bronchopulmonary aspergillosis in cystic fibrosis patients |
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