Prediction Of Clinical Response To Omalizumab In Moderate To Severe Asthma Patients Using The Change In Total Serum IgE

BackgroundBronchial asthma(referred to as asthma)is a common chronic airway inflammatory disease that harms people’s lives and health.Allergic asthma accounts for more than 60%of asthma,and immunoglobulin E(IgE)plays an important role in the pathophysiology of allergic reactions and airway inflammation.Omalizumab(OMA)is an effective anti-IgE treatment for most moderate to severe asthmatics.However,clinically,there is a lack of economical and reliable means of predicting efficacy.This study mainly explores the predictive effect of serum IgE changes on the efficacy of omazumab treatment through a prospective follow-up study,and analyzes the possible predictive effects of other clinical indicators.ObjectivesWe aimed to determine whether monitoring change of total IgE could predict response to OMA in moderate-to-severe asthma.27 patients were enrolled in a hospital’s outpatient department of respiratory and critical care medicine with moderate to severe persistent asthma treated with OMA for 16 weeks.Total IgE serum concentrations were measured at baseline and 4 weeks thereafter.The ratios of total serum IgE 4-week/baseline were calculated accordingly.Patients were divided into responders and non-responders by use of evaluations of global treatment effectiveness(GETE)response after 16 weeks of OMA treatment.The characteristics of responders and non-responders were compared and the receiver operating characteristic(ROC)curves were used to explore the prediction ability of IgE for the response.ResultsA total of 25 asthma patients completed 16 weeks of treatment and follow-up.11 females and 14 males,46.1 ± 15.3yrs,pre-bronchodilator FEV1 67.8±19.1%,and baseline total serum IgE 210(85-349.1)IU/mL.Investigators evaluated the effectiveness of OMA by GETE as excellent or good(responder)in 20 patients,80%,and in 5 patients,20%as moderate or poor(non-responder).Responders demonstrated better improvement of ACT,ACQ and reduction of oral corticosteroids compared with non-responders.Patients with the ratio of total serum IgE 4-week/baseline≥2 was 21,and 20 of the 21 patients responded to OMA.Four patients had this value<2,and all of them were ineffective.Baseline IgE and week 4 IgE for predicting response respectively achieved AUCs of 0.53(95%CI:0.18-0.88)and 0.69(95%CI:0.42-0.96).The 4-week/baseline achieved the highest AUC of 0.87(95%CI:0.64-1)and was significantly better than the baseline IgE and week 4 IgE.ConclusionsThe ratio of total serum IgE 4-week/baseline≥2 may predict response with a high likelihood after 16 weeks of anti-IgE treatment.Monitoring change of total IgE in patients treated with omalizumab may predict clinical response.