PURPOSE:Omalizumab is indicated for moderate to severe asthma with an IgE level between 30 - 700 IU/ml. Patients with steroid dependent asthma may have low IgE levels and do not fit usual criteria for approval of Omalizumab by third party payers. We describe 3 patients with steroid dependent asthma who had a low IgE level at baseline and were started on Omalizumab on a clinical basis.
METHODS:Patients n=3 with steroid dependent asthma with low IgE levels (Mean = 12 IU/ml) were identified and attempts to arrange Omalizumab were pursued with third party payers. Mean time to arrange Omalizumab was 5 weeks. Patients were followed clinically and their charts analyzed for steroid use and exacerbations 6 months prior and 6 months after starting Omalizumab. Impairment scores using ATS criteria were calculated before and after Omalizumab was started.
RESULTS:Average baseline IgE was 12 IU/ml. There was a decrease in ATS asthma impairment rating scores before and after starting Omalizumab 8.67 vs. 3.33. Average prednisone use per month before Omalizumab was 17 mg and after starting was 3.33 mg. Average hospitalizations before Omalizumab were 4 and after Omalizumab were 0.33 over a six-month period.
CONCLUSION:Omalizumab is a useful adjunct to treatment in patients with steroid dependent asthma despite low IgE levels. Omalizumab may help decrease steroid dependence and exacerbation rates thus, decreasing healthcare utilization in severe asthma.
CLINICAL IMPLICATIONS:Patients with steroid dependent asthma who do not meet usual criteria for use of Omalizumab due to low IgE levels may benefit from a trial of Omalizumab.
DISCLOSURE:Mary Zaremba, No Financial Disclosure Information; No Product/Research Disclosure Information