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Steroid sparing effect of omalizumab in seropositive allergic bronchopulmonary aspergillosis.

Beam KT, Coop CA - Allergy Rhinol (Providence) (2015)

Bottom Line: Antifungals have been used to reduce dependency on systemic steroids but long term use can be limited by side effects and there is the possibility of developing resistance to azoles.After therapy with omalizumab, our patient was able to reduce her need for daily corticosteroids by nearly 80%.Omalizumab may reduce corticosteroid dependence in patients with allergic bronchopulmonary aspergillosis for patients unable to tolerate antifungals, though use may be limited by cost.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, San Antonio Military Medical Center, San Antonio, Texas, USA.

ABSTRACT

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a common serious hypersensitivity reaction to airway colonization with Aspergillus in patients with asthma or cystic fibrosis. While steroids are effective in controlling the respiratory symptoms of ABPA, they have many side effects that make them undesirable for long term use. Antifungals have been used to reduce dependency on systemic steroids but long term use can be limited by side effects and there is the possibility of developing resistance to azoles. Some clinicians have successfully used anti-immunoglobulin E (anti-IgE) therapy in various populations, though it is frequently added to antifungals.

Objective: Further describe the utility of anti-IgE therapy for ABPA for patients unable to tolerate antifungals.

Methods: We describe the case of a patient with serologic ABPA who did not tolerate therapy with antifungals but was able to significantly reduce her average daily steroid use while receiving anti-IgE therapy with omalizumab added to her other respiratory medications.

Results: After therapy with omalizumab, our patient was able to reduce her need for daily corticosteroids by nearly 80%.

Conclusions: Omalizumab may reduce corticosteroid dependence in patients with allergic bronchopulmonary aspergillosis for patients unable to tolerate antifungals, though use may be limited by cost. Additional studies are needed. ClinicalTrial.gov identifier NCT00787917.

No MeSH data available.


Related in: MedlinePlus

Steroid dose versus medication.
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Figure 1: Steroid dose versus medication.

Mentions: In October 2013, the patient was started on omalizumab that was dosed as 450 mg subcutaneously every 2 weeks. This has continued to the present time. She required a burst of steroids ∼1 month into treatment (November 2013); however, she remained off daily steroids for ∼8 months. In May 2014, she was restarted on low-dose maintenance steroids at 10 mg every other day because she began to experience worsening of her respiratory symptoms and had decreasing peak flows. We calculated the patient's average daily dose of prednisone during each clinical situation and present these data in Fig. 1. This shows nearly an 80% reduction in the average daily steroid use after the patient was started on omalizumab. IgE levels also decreased and were down to 1172 IU/mL most recently. In addition, there was a marked decrease in unplanned health care utilization after starting omalizumab. Before starting omalizumab, our patient was seeing her allergist or pulmonologist on average approximately once every other month, in addition to multiple emergency department (ED) visits and several hospitalizations. After starting omalizumab, she has had only one ED visit and has seen her allergist only twice over the past 17 months. Both of these visits were scheduled. Although omalizumab is expensive, some of this cost may be offset by decreases in ED visits, hospitalizations, clinic visits, and the patient's days off work and quality of life. This would be an interesting topic for additional study.


Steroid sparing effect of omalizumab in seropositive allergic bronchopulmonary aspergillosis.

Beam KT, Coop CA - Allergy Rhinol (Providence) (2015)

Steroid dose versus medication.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541638&req=5

Figure 1: Steroid dose versus medication.
Mentions: In October 2013, the patient was started on omalizumab that was dosed as 450 mg subcutaneously every 2 weeks. This has continued to the present time. She required a burst of steroids ∼1 month into treatment (November 2013); however, she remained off daily steroids for ∼8 months. In May 2014, she was restarted on low-dose maintenance steroids at 10 mg every other day because she began to experience worsening of her respiratory symptoms and had decreasing peak flows. We calculated the patient's average daily dose of prednisone during each clinical situation and present these data in Fig. 1. This shows nearly an 80% reduction in the average daily steroid use after the patient was started on omalizumab. IgE levels also decreased and were down to 1172 IU/mL most recently. In addition, there was a marked decrease in unplanned health care utilization after starting omalizumab. Before starting omalizumab, our patient was seeing her allergist or pulmonologist on average approximately once every other month, in addition to multiple emergency department (ED) visits and several hospitalizations. After starting omalizumab, she has had only one ED visit and has seen her allergist only twice over the past 17 months. Both of these visits were scheduled. Although omalizumab is expensive, some of this cost may be offset by decreases in ED visits, hospitalizations, clinic visits, and the patient's days off work and quality of life. This would be an interesting topic for additional study.

Bottom Line: Antifungals have been used to reduce dependency on systemic steroids but long term use can be limited by side effects and there is the possibility of developing resistance to azoles.After therapy with omalizumab, our patient was able to reduce her need for daily corticosteroids by nearly 80%.Omalizumab may reduce corticosteroid dependence in patients with allergic bronchopulmonary aspergillosis for patients unable to tolerate antifungals, though use may be limited by cost.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, San Antonio Military Medical Center, San Antonio, Texas, USA.

ABSTRACT

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a common serious hypersensitivity reaction to airway colonization with Aspergillus in patients with asthma or cystic fibrosis. While steroids are effective in controlling the respiratory symptoms of ABPA, they have many side effects that make them undesirable for long term use. Antifungals have been used to reduce dependency on systemic steroids but long term use can be limited by side effects and there is the possibility of developing resistance to azoles. Some clinicians have successfully used anti-immunoglobulin E (anti-IgE) therapy in various populations, though it is frequently added to antifungals.

Objective: Further describe the utility of anti-IgE therapy for ABPA for patients unable to tolerate antifungals.

Methods: We describe the case of a patient with serologic ABPA who did not tolerate therapy with antifungals but was able to significantly reduce her average daily steroid use while receiving anti-IgE therapy with omalizumab added to her other respiratory medications.

Results: After therapy with omalizumab, our patient was able to reduce her need for daily corticosteroids by nearly 80%.

Conclusions: Omalizumab may reduce corticosteroid dependence in patients with allergic bronchopulmonary aspergillosis for patients unable to tolerate antifungals, though use may be limited by cost. Additional studies are needed. ClinicalTrial.gov identifier NCT00787917.

No MeSH data available.


Related in: MedlinePlus