Omalizumab in the Era of Precision Medicine

Omalizumab in the Era of Precision Medicine

Allergic allergy has been increasing in Hong Kong given evolutionary and genetic or environmental factors. Omalizumab, or anti-IgE, is a monoclonal antibody approved for use in Hong Kong, primarily to treat severe persistent allergic asthma. Professor David Price, Director of OPRI, spoke at the Hong Kong Institute of Allergy Annual Scientific Meeting 2019 about the knowledge gap in terms of omalizumab use, and how best to maximise the efficacy of this targeted therapy.

With severe asthma comes several burdens. Many of those who suffer from this condition experience a diminished quality of life; they often feel alone and physically limited and as if they are unable to perform simple tasks in their daily lives. Furthermore, they are typically prescribed repeated courses of oral corticosteroid (OCS). Chronic OCS use has been associated with many side effects such as osteoporosis, diabetes, and pneumonia. Therefore, new treatments which reduce the prevalence of these comorbidities are highly desirable. 

In recent years, several biologics have been successfully developed and approved for use as treatment for severe asthma based on disease phenotyping and the biomarkers that present in patients. Omalizumab, in particular, has been shown to treat type 2 asthma; multiple randomized controlled trials have shown that it can significantly reduce the number of exacerbations in those with severe asthma as well as improve their quality of life.

Real-life studies on the efficacy of omalizumab showed similarly positive results – patients undergoing treatment with this medication reported a significant increase in their quality of life. Omalizumab also reduced the number of patients who had to undergo maintenance oral corticosteroid (OCS) therapy and many of those who continued with it could reduce their dosage. It therefore presents as a promising treatment option for severe asthma.

Certain biomarkers can predict a patient’s response to omalizumab therapy. Individuals with high levels of FeNO, periostin and eosinophil counts are more likely to have a better response to this therapy. This allows for a more personalized approach to treatment according to an individual’s genetic makeup, an approach known as precision medicine.

Omalizumab can also provide benefits after discontinuation of the therapy. These benefits include, but are not limited to, improved respiratory function and fewer exacerbation and hospitalization events. Studies show that 6 years of therapy with omalizumab is required to obtain these benefits which persist for a minimum of 3 years, during which, the patient is no longer considered to have severe asthma but rather mild and stable asthma.

Overall, the research conducted on omalizumab thus far is very promising as it has been noted to decrease exacerbations and better control asthma symptoms as compared to the currently available treatment options for severe asthma. It also allows for the reduction of OCS use, which is a significant benefit for individuals with this condition. Due to its success in both controlled and real-life studies, a new treatment paradigm for asthma encompassing biologic therapy is proposed for use in practice.