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Obstructive Lung Diseases |

Clinical Utilization Pattern and Effectiveness of Omalizumab for Asthma Patients in Israel

Shiri Guy-Alfandary*, PharmD; Barak Nahir, MD; Yifat Namer-Tal, MD; Meir Raz, MD
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Maccabi Healthcare Organization, Modi'in, Israel


Chest. 2012;142(4_MeetingAbstracts):707A. doi:10.1378/chest.1388997
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Abstract

SESSION TYPE: Asthma Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To describe Omalizumab clinical utilization pattern and its effectiveness in Maccabi Healthcare Organization and to determine the need for a clinical decision tool as well as a control system for prescribing and administering Omalizumab in everyday practice.

METHODS: 109 patients, treated with Omalizumab during 2006-2010 were evaluated in a historical prospective study. Analysis was performed for dosage adjustment, prescribing criteria suitability, patients’ adherence and reasons for drug discontinuation. Effectiveness was evaluated using physician and patient questionnaires, comparing asthma drugs consumption and unscheduled healthcare utilization pre and post Omalizumab initiation.

RESULTS: Of the 109 patients 39.4% received inappropriate monthly Omalizumab doses, mainly under-dose (70%). 55% discontinued Omalizumab. Reasons for discontinuation were unsatisfactory therapeutic effect (32%), financial burden (23%), adverse reactions (13%), fear of adverse reactions (13%), lifestyle modifications (10%) and other (10%). Mean duration for discontinuation was 10 months. Criteria for Omalizumab initiation included moderate to severe asthma documented in 88% of the patients. 14% were also diagnosed with other lung diseases such as eosinophilic pneumonia, Churg strauss vasculitis, bronchiectasis, primary cilliary dyskinesia and sarcoidosis in which clear indication for Omalizumab cannot be identified. 17% had no reversible airflow limitation consistent with asthma, 13% had negative allergic tests and 20% had no documentation of allergy tests. Compared to the previous year, patients experienced 70.4% fewer annualized hospitalizations and 62.5% fewer annualized emergency department visits for respiratory exacerbations. Daily average systemic steroid consumption decreased in 80% of patients. 73% of physicians and 91% of patients reported good to excellent response to Omalizumab treatment.

CONCLUSIONS: Omalizumab in medical practice in Israel provided a similar benefit to that observed in clinical trials. Errors in dosing together with inappropriate patient selection may limit or overestimate therapeutic effect.

CLINICAL IMPLICATIONS: Implementing responders' algorithm as a clinical decision tool for continuation of Omalizumab at the 16 week point combined with an ordered application forms for both initiation and continuation of Omalizumab may minimize medical errors, optimize treatment effectiveness and reduce overall expenditures.

DISCLOSURE: Meir Raz: Grant monies (from industry related sources): Novartis

The following authors have nothing to disclose: Shiri Guy - Alfandary, Barak Nahir, Yifat Namer - Tal

No Product/Research Disclosure Information

Maccabi Healthcare Organization, Modi'in, Israel

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