• Stefan Zielen, Adrian Lieb, Stephan De La Motte, Frank Wagner, Jan de Monchy, Rainard Fuhr, Clara Munzu, Stephan Koehne-Voss, Gilles-Jacques Rivière, Guenther Kaiser, and Veit J Erpenbeck.
• Department of Pediatric Allergy, Pneumology and Cystic Fibrosis, University Children's Hospital, J.W. Goethe University, Frankfurt, Germany. Stefan.Zielen@kgu.de
• Int. Arch. Allergy Immunol. 2013 Jan 1; 160 (1): 102-10.

BackgroundOmalizumab has been shown to suppress responses to inhaled allergens in allergic asthma patients with pretreatment immunoglobulin E (IgE) ≤700 IU/ml. To extend current dosing tables, we evaluated the potential of high omalizumab doses to block allergen-induced bronchoconstriction in patients with higher IgE levels.MethodsAsthmatic adults (18-65 years; body weight 40-150 kg) were divided into groups according to screening IgE (group 1: 30-300 IU/ml; group 2: 700-2,000 IU/ml) and randomized 2:1 to omalizumab/placebo every 2 or 4 weeks for 12-14 weeks. Allergen bronchoprovocation (ABP) testing was performed before treatment and at weeks 8 and 16. The primary efficacy endpoint, the early-phase allergic response (EAR), was defined as the maximum percentage drop in forced expiratory volume in 1 s during the first 30 min after ABP. Serum free IgE was determined as a pharmacodynamic endpoint, and the exhaled fractional concentration of nitric oxide (FE(NO)) was an exploratory endpoint.ResultsFifty patients were included in the study. Omalizumab improved EAR; at week 8, EAR was 23.1% for placebo, 9.3% in group 1 (p = 0.018 versus placebo) and 5.6% in group 2 (p < 0.001). At week 16, EAR was 20%, 11.8% (p = 0.087) and 5.1% (p < 0.001), respectively. Free IgE decreased in groups 1 and 2 and remained <50 ng/ml in all patients during weeks 6-16. Omalizumab completely suppressed FE(NO) increases after ABP in both groups.ConclusionsOmalizumab blocked early asthmatic responses over a broad range of IgE/body weight combinations. Extending the dosing tables enables omalizumab to benefit a wider range of patients.Copyright © 2012 S. Karger AG, Basel.

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