Asthma in older adults is under-diagnosed, under-treated, and the role of immunoglobulin E (IgE) in asthma is under-appreciated in this population . Therapy with omalizumab (OMA), an anti-IgE antibody, is indicated in patients with moderate to severe IgE-mediated asthma whose remain symptomatic despite inhaled corticosteroids. We conducted a pooled analysis of all double-blind placebo-controlled trials to evaluate the effect of OMA on asthma symptom score and rescue beta-agonist use in patients 50 years and older.
Data were combined from 5 randomized double blind placebo-controlled (PBO) trials of patients with moderate to severe IgE-mediated asthma; 4 were of 28 weeks and 1 was 32 weeks in duration. From the pooled study population comprised of 2236 patients, 601 were ≥ 50 years of age (296 OMA, 305 PBO). The change from baseline in mean total asthma symptom score [range 0 (symptom free) to 9], and in mean beta-agonist rescue puffs was assessed using an analysis of covariance. Least-squares mean treatment differences were calculated and 95% confidence intervals were constructed.
The mean age of the older subgroup was 58 years; 61% were female; median IgE level was 132 IU/dl; mean percent predicted FEV1 64.6% ± 17.0%; baseline mean total asthma symptom score was 3.35 (OMA) and 3.40 (PBO), and baseline mean daily rescue beta-agonist use was 4.48 puffs (OMA) and 4.37 puffs (PBO). In this subpopulation, least-squares mean difference (OMA-PBO) for change from baseline in mean asthma symptom score was -0.26 (95% CI -0.51, -0.01; p=0.0411) and least-squares mean difference for change from baseline in rescue beta-agonist puffs was -0.47 (95% CI -0.92, -0.02; p=0.0414). The tolerability profile of OMA in the ≥ 50 year age subgroup was generally similar to that of the overall study population.
Treatment with omalizumab significantly improved asthma symptoms and reduced beta-agonist use in older patients with moderate to severe persistent IgE-mediated asthma.
IgE-mediated asthma is important to recognize and manage in older patients.
Robert Maykut, Employee I am an employee of Novartis Pharmaceuticals Corporation.