AĞIR ALLERJİK ASTIMDA 1 YILLIK ANTİ-IGE (OMALİZUMAB) DENEYİMİMİZ

Year 2017, Volume: 31 Issue: 3, 165 - 172, 01.12.2017

Ferda Bilgir Bilge Özdemir Papatya Değirmenci Bahadır Dede Cengiz Kırmaz

Abstract

Amaç: Standart tedavilere yanıtsız orta ve ağır
alerjik astımda anti IgE (Omalizumab) tedavisinin
etkili ve yararlı olduğu bilinmektedir. Bu çalışmada
omalizumab tedavisi uyguladığımız alerjik astımlı
hastalarımızın verilerinin paylaşılması amaçlandı.
Yöntem ve Gereç: Kliniğimizde omalizumab
tedavisi uygulanan ağır alerjik astımlı 23 hastanın
dosya kayıtları ve bilgi formları retrospektif olarak
incelendi. Allerjen duyarlılığı deri prik testi ile
saptandı. Omalizumab tedavisi öncesi ve tedavinin
1.yılı sonundaki serum total IgE, Astım Kontrol
Testi, kullanılan ilaç sayısı, acil başvurusu, FEV1,
FEV1/FVC değerleri karşılaştırıldı.
Bulgular: Yaş ortalaması 45.78±10.71 yıl, hastalık
süresi ortalaması 13.69±9.04 yıl olan 23 hastanın
%69.6’sı kadın (n=16) idi. Astıma ek olarak
hastaların %65.2’sinde alerjik rinit, %34.8’indeürtiker, %13’ünde ilaç allerjisi, %8.7’sinde gıda
allerjisi, %4.3’ünde latex allerjisi vardı. Ev tozu
akarı duyarlılığı %78.3, ev tozu akarı + diğer
inhalan allerjen duyarlılığı %21.7 idi. Omalizumab
tedavisinin 1.yılı sonunda kullanılan astım ilaçları
sayısında, acil başvurusunda, serum total IgE ve
FEV1/FVC’de azalma (P<0.05), astım kontrol testi
puanlarında artma (P<0.05) saptandı.
Sonuç: Hastalarımızda omalizumab tedavisinin
etkili ve güvenli olduğu, iyi tolere edildiği görüldü.
Standart tedavilerle kontrol sağlanamayan ağır
alerjik astımlı hastalarda omalizumab tedavisinin
yararlı olduğunu düşünmekteyiz.

Keywords

Astım, omalizumab, allerji

OUR ANTI-IGE (OMALIZUMAB) EXPERIENCE IN SEVERE ALLERGIC ASTHMA: 1ST YEAR EXPERIENCE

Abstract

Aim: Anti-IgE (omalizumab) therapy is known to be
effective and useful in moderate to severe allergic
asthma without response to standard treatments.
This study aimed to share the data of our allergic
asthmatic patients with omalizumab treatment.
Material and Methods: The records and data
sheets of 23 patients with severe allergic asthma
who underwent omalizumab treatment were
retrospectively reviewed in our clinic. Sensitivity
to allergen was detected by skin prick test. Serum
total IgE, Astma Control Test, number of
medications used, urgent admission, FEV1, FEV1 /
FVC values were compared before and after
omalizumab treatment.
Results: The mean age was 45.78 ± 10.71 years
and the mean time of ilness of the patients were
13.69 ± 9.04 years. Of the 23 patients, 69.6% were female (n = 16). In addition to asthma,
65.2% of patients had allergic rhinitis, 34.8% had
urticaria, 13% had drug allergy, 8.7% had food
allergy, and 4.3% had latex allergies. House dust
mite sensitivities were 78.3%, house dust mite +
other inhaled allergen sensitivities were 21.7%.
The number of asthma medications, serum total
IgE and FEV1 / FVC decreased (P <0.05) andasthma
control test scores increased (P <0.05) at the end
of the 1st year of omalizumab treatment.
Conclusion:It has been shown that omalizumab
treatment is effective and safe and well tolerated
in our patients. We think that omalizumab
treatment is useful in patients with severe allergic
asthma who can not be controlled by standard
treatments.

Keywords

Asthma, omalizumab, allergy

References

• 1. Pocket Guide for Asthma Management and Prevention, Global Initiative for Asthma (GINA) Report 2016. Available from: http://www. ginasthma.org/2016-pocket-guide-for-asthmamanagement-and-prevention/ (Accessed June 28, 2016)
• 2. D’Amato G. Role of anti-IgE monoclonal antibody (omalizumab) in Panwakar R,Canonic GW, Holgate ST,Lockey RF;Section 2.2 Asthma; World Allergy Organization (WAO) White BOOK on Allergy;WAO;2011;33-8.
• 3. Kurt E,Metintaş S,Başyiğit I,Bulut I,Coşkun E,Dabak S et al.Prevalance and risk factors allergies in Turkey: Results of a multisentric cross-sectional study in adults.Eur Respir J 2009;33:724-33.
• 4. Rabe KF,Adachi M, Lai CKW,et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol 2004;114:40-7.
• 5. Şekerel BE,Gemicioğlu B, Soriano JB. Asthma insights and reality in Turkey (AIRET) study.Respir Med 2006;100:1850-4.
• 6. Lugogo NL, MacIntyre NR. Life-threatening asthma: pathophysiology and management. Respir Care 2008;53(6):726-39.
• 7. Buhl R. Anti-IgE antibodies for the treatment of asthma. Curr Opin Pulm Med 2005;4:27-34.
• 8. D’Amato G.Role of anti IgE monoclonal antibody (omalizumab) in the treatment of bronchial asthma and allergic respiratory diseases. Eur Respir Pharmal 2006;533302-7.
• 9. Karpel J, Massanari M, Geba GP, Kianifard F, Inhaber N, Zeldin RK.Effectiveness of omalizumab in reducing corticosteroid burden in patients with moderate to severe persistent allergic asthma. Ann Allergy Asthma Immunol. 2010; 105: 465-70.
• 10. Global Strategy for Asthma Management and Prevention, GINA Report 2016. Available from: http://www.ginasthma.org/2016-ginareportglobal-strategy-for-asthma-managementand-prevention/ (Accessed June 28, 2016)
• 11. Lai T, Wang S, Xu Z, Zhang C, Zhao Y, Hu Y, et al. Long-term efficacy and safety of omalizumab in patients with persistent uncontrolled allergic asthma: a systematic review and meta-analysis. Sci Rep 2015;5: 8191.
• 12. Corren J, Casale T, Lanier B, Buhl R, Holgate S, Jimenez P. Safety and tolerability of omalizumab. Clin Exp Allergy. 2009; 39: 788- 97.
• 13. Caminati M, Senna G, Guerriero M, Dama AR, Chieco-Bianchi F, Stefanizzi G, et al. Omalizumab for severe allergic asthma in clinical trials and real-life studies: What we know and what we should address. Pulmonary pharmacology & therapeutics. 2015; 31: 28-35.
• 14. Molimard M, Buhl R, Niven R,et al. Omalizumad reduces oral corticosteroid use in patients with severe allergic asthma: real life data.Respir Med 2010;104:1381-5.
• 15. Vignola AM, Humbert M, Bousquet J, et al. Efficacy and tolerability of anti-immunoglobulin E therapy with omalizumab in patients with concomitant allergic asthma and persistent allergic rhinitis: SOLAR. Allergy 2004; 59:709- 17.
• 16. Bousquet J, Cabrera P, Berkman N, et al. The effect of treatment with omalizumab, an antiIgE antibody, on asthma exacerbations and emergency medical visits in patients with severe persistent asthma. Allergy 2005; 60:302-8.
• 17. Abraham I, Alhossan A, Lee CS, Kutbi H, MacDonald K. ‘Real-life’ effectiveness studies of omalizumab in adult patients with severe allergic asthma: systematic review. Allergy 2016 Allergy; 71: 593-610.
• 18. Korn S, Thielen A, Seyfried S, Taube C, Kornmann O,Buhl R. Omalizumab in patients with severe persistent allergic asthma in a reallife setting in Germany. Respir Med 2009; 103: 1725-31.
• 19. Brusselle G, Michils A, Louis R, et al. “Real-life” effectiveness of omalizumab in patients with severe persistent allergic asthma: The PERSIST study. Respir Med 2009;103: 1633-42
• 20. Cazzola M, Camiciottoli G, Bonavia M, et al. Italian reallife experience of omalizumab. Respir Med 2010; 104:1410-6.
• 21. Bavbek S, Aydın O, Kepil Ozdemir S,Yılmaz I, Celik GE, Demirel YS, et al. Therapy with omalizumab in patients with severe persistent allergic asthma: A real life data in Turkey. Tuberk Toraks 2010; 58: 425-34.
• 22. Ozgur ES, Ozge C, Ilvan A, Naycı SA. Assessment of long-term omalizumab treatment in patients with severe allergic asthma long-term omalizumab treatment in severe asthma. J Asthma 2013; 50: 687-94.
• 23. Tat TS, Cilli A. Omalizumab treatment in asthma-COPD overlap syndrome.J Asthma 2016; 53: 1048-50.
• 24. Effectiveness evaluation of anti-IgE treatment at 3rd year: Real life Turkey data Ayse Arzu Yorgancioglu, Ferda Öner Erkekol, Münevver Erdinç, Dilsad Mungan, Bilun Gemicioglu, Zeyn ep Ferhan Özseker, Papatya Bayrak Degirmenci, Sibel Nayci, Aykut Çilli, Füsun Erdenen, Cengiz Kirmaz, Dane Ediger, Arzu Didem Yalçin, Suna Büyüköztürk, Sami Büyüköztürk, Mustafa Güleç, Rana Isik, Ali Fuat Kalyoncu, Özlem Göksel, Ömür Aydin, Yavuz Havlucu, Idilhan Baloglu Ar, Ahmet Erdogdu European Respiratory Journal 2016 48: PA3381; DOI: 10.1183/1399300.
• 25. Nathan RA, Sorkness CA, Kosinski M, Schatz M,Li JT, Marcus P, Murray JJ, Pendergraft TB. Development of the asthma control test: A survey for assescing asthma control. J Allergy Clin Immunol 2004;113(1):59-65.
• 26. Schatz M, Zeiger RS, Drane A, et al. Reliability and predictive validity of the Asthma Control Test administered by telephone calls using speech recognition tecnology. J Allergy Clin Immunol 2007;119:336-43.
• 27. Marcus P.Incorporating anti-IgE (omalizumab) therapy into pulmonary medicine practice.Chest 2006;129:466-74.
• 28. Cox L, Platts-Mills TA, Finegold I, Schwartz LB,Simons FE, Wallace DV. American Academy of Allergy, Asthm & Immunology; American College of Allergy, Asthma and Immunology. Joint Task Force Report on omalizumab associated anaphylaxis. J Allergy Clin Immunol 2007;120(6):1373-7.
• 29. Zar JH. Biostatistical analysis. 2nd ed. Englewood Cliffs, N.J.: Prentice-Hall, 1984.
• 30. Strunk RC,Bloomberg GR. Omalizumab for asthma. N Engl J Med 2006;354:2689-95.
• 31. Navarro A, Valero A,Julia B, Quirce S. Coexistence of asthma and allergic rhinitis in adult patients attending allergy clinics: ONEAIR study. J Investig Allergol Clin Immunol. 2008; 18:233-8.
• 32. Nathan RA. Management of patients with allergic rhinitis and asthma:literatüre review.South Med J.2009;102: 935-41.
• 33. Corren J, Casale T, Lanier BQ, Blogg M, Reisner C, Gupta N. Omalizumab is well tolerated inadolescen /adult paitnts (12 years) with moderate-to-severe persistent asthma. J Allergy Clin Immunol 2005;115:75.
• 34. SandströmT.Targeting immunoglobulin E as a novel treatment for asthma. Curr Allergy Astma Rep 2005;5:109-15.
• 35. Sullivan SD, Rasouliyan L, Russo PA, Kamath T, Chipps BE; fort he TENOR Study Group. Extent, patterns, and burden of uncontrolled disease in severe or difficult-to-treat asthma. Allergy 2007; 62:126-33.
• 36. Seung SJ, Mittman N. Urgent care costs of uncontrolled asthma in Canada, 2004. Can Respir J 2005;12:435-6.
• 37. Santos LA, Oliveira MA, Faresin SM, Santoro LL, Fernandes ALG. Direct costs of asthma in Brazil: a comparison between controlled and uncontrolled asthmatic patients. Braz J Med Biol Res 2007;40: 943-8.
• 38. Accordini S, Bugiani M, Arossa W, Gerzeli S, Marinoni A, Olivieri M, et al. Poor control increases the economic cost of asthma. Int Arch Allergy Immunol 2006;141:189-98.