Omalizumab in severe allergic asthma associated with COPD: a multicentric cohort study

Abstract

Omalizumab is a treatment for severe uncontrolled allergic asthma. Few data are available on its efficacy when asthma coexists with chronic obstructive pulmonary disease (COPD), although overlap (ACO) is common. Our study aimed to describe the characteristics of ACO patients treated with omalizumab.

Method: Retrospective data from consecutive asthmatic patients treated with omalizumab between 2010 and 2019 in 6 French university hospitals. ACO criteria were: age > 40 years, smoking > 10 pack-years, post-bronchodilator FEV1/FVC < LLN. Data collection included: mMRC dyspnea scale, asthma control test (ACT), exacerbations rate and FEV1, before and after 3 and 12 months of treatment.

Results: Among 701 severe allergic asthmatics treated with omalizumab, 123 had ACO criteria (17%). ACO patients (n=101 with complete data) were 58 years old [52;65], 59% were male with smoking history of 20 pack-years [15;30], mMRC 3 [2;3], ACT 12 [9;16], 6 exacerbations in the previous year [4;12] and FEV1 63 % pred [46;76].

At 3 months, mMRC improved from 3 [2;3] to 2 [1;3]* and ACT from 12 [9;16] to 15 [12;21]*. 28 patients discontinued omalizumab before 12 months, mainly because of treatment failure.

At 12 months, in the 73 patients who continued omalizumab, mMRC improved from 3 [2;3] to 2 [1;2]*, ACT from 12 [9;16] to 18 [14;23]* and exacerbation rate decreased from 6 in the previous year [4;10] to 1 during the year of treatment [0;2]*, with no change in FEV1. * p < 0,001

Conclusion: In severe allergic asthma coexisting with COPD, omalizumab was discontinued in 28% of patients. In those who continued, omalizumab use was associated with an improvement of dyspnea, asthma symptoms and exacerbations rate.