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How to evaluate a patient's response to anti-IgE

CORRESPONDENCE: S. T. Holgate, Southampton General Hospital, RCMB Division, Mailpoint 810, Level D, Centre Block, Southampton SO16 6YD, UK. Fax: 44 2380701771. E-mail: sth{at}soton.ac.uk

Omalizumab, an anti-immunoglobulin E antibody, is indicated in the European Union (EU) as add-on therapy for patients with severe persistent allergic asthma whose symptoms persist, despite receiving optimised treatment with high-dose inhaled corticosteroids and a long-acting ß₂-agonist. In an attempt to further optimise the use of omalizumab, studies have been performed to investigate whether patient selection for omalizumab therapy could be further enhanced.

Analyses of pre-treatment baseline variables have shown there is no reliable way to predict which patients within the label population will achieve a greater response to omalizumab. However, a physician's overall assessment can easily and reliably identify patients who respond to omalizumab. All patients eligible for omalizumab treatment should receive a 16-week trial and treatment should only be continued if the physician judges that a marked improvement in asthma control has been achieved, as specified in the EU label.

By continuing treatment only in patients who respond to omalizumab therapy, unwarranted drug exposure is minimised, while treatment benefit and cost effectiveness of the therapy are maximised.

KEYWORDS: Allergic asthma, anti-immunoglobulin E, omalizumab