Omalizumab in patients with eosinophilic granulomatosis with polyangiitis: a 36-month follow-up study

J Asthma. 2016;53(2):201-6. doi: 10.3109/02770903.2015.1081700. Epub 2015 Sep 17.

Abstract

Objective: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis characterized by asthma and blood eosinophilia, with the lung being the organ most frequently affected. Oral glucocorticoids and/or immunosuppressive drugs are the mainstay therapy of EGPA. Occasional reports suggest that EGPA patients can be treated with omalizumab in addition to conventional therapy to achieve asthma control. To investigate the long-term effects of omalizumab in patients with EGPA and asthma (2 females, 3 males, age 41-64 years), we carried out a 36-month follow-up observational study. At the time of enrollment, the patients were on maintenance therapy and had moderate to severe allergic asthma, eosinophilia and rhinosinusitis. Mononeuropathy/polyneuropathy and/or histological evidence of tissue eosinophilic infiltration were also present.

Methods: Patients were treated with omalizumab (300-600 mg s.c. every 2-4 weeks) as add-on therapy to prednisone, inhaled steroids and bronchodilators. During omalizumab treatment, spirometry, the asthma control test (ACT) score and eosinophilia were evaluated, and prednisone dosage was recorded.

Results: During the 36 months of omalizumab treatment asthma progressively improved as indicated by spirometry and the ACT score. Eosinophilia progressively decreased. The oral prednisone dose was reduced or withdrawn during treatment. No adverse events were recorded.

Conclusions: In patients with EGPA and moderate to severe allergic asthma, omalizumab can be beneficial and safe. It enables corticosteroid tapering while decreasing eosinophilia and improving asthma symptoms over 36 months.

Keywords: Case reports; control/management; morbidity and mortality; pharmacotherapy; therapy.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Drug Therapy, Combination
  • Eosinophilia / drug therapy*
  • Eosinophilia / physiopathology
  • Female
  • Forced Expiratory Volume
  • Glucocorticoids / therapeutic use
  • Granulomatosis with Polyangiitis / drug therapy*
  • Granulomatosis with Polyangiitis / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Omalizumab / therapeutic use*
  • Prednisone / therapeutic use
  • Spirometry
  • Treatment Outcome

Substances

  • Anti-Asthmatic Agents
  • Glucocorticoids
  • Omalizumab
  • Prednisone