Ferda BİLGİR, Bilge ÖZDEMİR, Papatya DEĞİRMENCİ, Bahadır DEDE, Cengiz KIRMAZ

AĞIR ALLERJİK ASTIMDA 1 YILLIK ANTİ-IGE (OMALİZUMAB) DENEYİMİMİZ

Amaç: Standart tedavilere yanıtsız orta ve ağır alerjik astımda anti IgE (Omalizumab) tedavisinin etkili ve yararlı olduğu bilinmektedir. Bu çalışmada omalizumab tedavisi uyguladığımız alerjik astımlı hastalarımızın verilerinin paylaşılması amaçlandı. Yöntem ve Gereç: Kliniğimizde omalizumab tedavisi uygulanan ağır alerjik astımlı 23 hastanın dosya kayıtları ve bilgi formları retrospektif olarak incelendi. Allerjen duyarlılığı deri prik testi ile saptandı. Omalizumab tedavisi öncesi ve tedavinin 1.yılı sonundaki serum total IgE, Astım Kontrol Testi, kullanılan ilaç sayısı, acil başvurusu, FEV1, FEV1/FVC değerleri karşılaştırıldı. Bulgular: Yaş ortalaması 45.78±10.71 yıl, hastalık süresi ortalaması 13.69±9.04 yıl olan 23 hastanın %69.6’sı kadın (n=16) idi. Astıma ek olarak hastaların %65.2’sinde alerjik rinit, %34.8’indeürtiker, %13’ünde ilaç allerjisi, %8.7’sinde gıda allerjisi, %4.3’ünde latex allerjisi vardı. Ev tozu akarı duyarlılığı %78.3, ev tozu akarı + diğer inhalan allerjen duyarlılığı %21.7 idi. Omalizumab tedavisinin 1.yılı sonunda kullanılan astım ilaçları sayısında, acil başvurusunda, serum total IgE ve FEV1/FVC’de azalma (P<0.05), astım kontrol testi puanlarında artma (P<0.05) saptandı. Sonuç: Hastalarımızda omalizumab tedavisinin etkili ve güvenli olduğu, iyi tolere edildiği görüldü. Standart tedavilerle kontrol sağlanamayan ağır alerjik astımlı hastalarda omalizumab tedavisinin yararlı olduğunu düşünmekteyiz.

Anahtar Kelimeler:

Astım, omalizumab, allerji

OUR ANTI-IGE (OMALIZUMAB) EXPERIENCE IN SEVERE ALLERGIC ASTHMA: 1ST YEAR EXPERIENCE

Aim: Anti-IgE (omalizumab) therapy is known to be effective and useful in moderate to severe allergic asthma without response to standard treatments. This study aimed to share the data of our allergic asthmatic patients with omalizumab treatment. Material and Methods: The records and data sheets of 23 patients with severe allergic asthma who underwent omalizumab treatment were retrospectively reviewed in our clinic. Sensitivity to allergen was detected by skin prick test. Serum total IgE, Astma Control Test, number of medications used, urgent admission, FEV1, FEV1 / FVC values were compared before and after omalizumab treatment. Results: The mean age was 45.78 ± 10.71 years and the mean time of ilness of the patients were 13.69 ± 9.04 years. Of the 23 patients, 69.6% were female (n = 16). In addition to asthma, 65.2% of patients had allergic rhinitis, 34.8% had urticaria, 13% had drug allergy, 8.7% had food allergy, and 4.3% had latex allergies. House dust mite sensitivities were 78.3%, house dust mite + other inhaled allergen sensitivities were 21.7%. The number of asthma medications, serum total IgE and FEV1 / FVC decreased (P <0.05) andasthma control test scores increased (P <0.05) at the end of the 1st year of omalizumab treatment. Conclusion:It has been shown that omalizumab treatment is effective and safe and well tolerated in our patients. We think that omalizumab treatment is useful in patients with severe allergic asthma who can not be controlled by standard treatments.

Keywords:

Asthma, omalizumab, allergy,

PDF

___

1. Pocket Guide for Asthma Management and Prevention, Global Initiative for Asthma (GINA) Report 2016. Available from: http://www. ginasthma.org/2016-pocket-guide-for-asthmamanagement-and-prevention/ (Accessed June 28, 2016)
2. D’Amato G. Role of anti-IgE monoclonal antibody (omalizumab) in Panwakar R,Canonic GW, Holgate ST,Lockey RF;Section 2.2 Asthma; World Allergy Organization (WAO) White BOOK on Allergy;WAO;2011;33-8.
3. Kurt E,Metintaş S,Başyiğit I,Bulut I,Coşkun E,Dabak S et al.Prevalance and risk factors allergies in Turkey: Results of a multisentric cross-sectional study in adults.Eur Respir J 2009;33:724-33.
4. Rabe KF,Adachi M, Lai CKW,et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol 2004;114:40-7.
5. Şekerel BE,Gemicioğlu B, Soriano JB. Asthma insights and reality in Turkey (AIRET) study.Respir Med 2006;100:1850-4.
6. Lugogo NL, MacIntyre NR. Life-threatening asthma: pathophysiology and management. Respir Care 2008;53(6):726-39.
7. Buhl R. Anti-IgE antibodies for the treatment of asthma. Curr Opin Pulm Med 2005;4:27-34.
8. D’Amato G.Role of anti IgE monoclonal antibody (omalizumab) in the treatment of bronchial asthma and allergic respiratory diseases. Eur Respir Pharmal 2006;533302-7.
9. Karpel J, Massanari M, Geba GP, Kianifard F, Inhaber N, Zeldin RK.Effectiveness of omalizumab in reducing corticosteroid burden in patients with moderate to severe persistent allergic asthma. Ann Allergy Asthma Immunol. 2010; 105: 465-70.
10. Global Strategy for Asthma Management and Prevention, GINA Report 2016. Available from: http://www.ginasthma.org/2016-ginareportglobal-strategy-for-asthma-managementand-prevention/ (Accessed June 28, 2016)
11. Lai T, Wang S, Xu Z, Zhang C, Zhao Y, Hu Y, et al. Long-term efficacy and safety of omalizumab in patients with persistent uncontrolled allergic asthma: a systematic review and meta-analysis. Sci Rep 2015;5: 8191.
12. Corren J, Casale T, Lanier B, Buhl R, Holgate S, Jimenez P. Safety and tolerability of omalizumab. Clin Exp Allergy. 2009; 39: 788- 97.
13. Caminati M, Senna G, Guerriero M, Dama AR, Chieco-Bianchi F, Stefanizzi G, et al. Omalizumab for severe allergic asthma in clinical trials and real-life studies: What we know and what we should address. Pulmonary pharmacology & therapeutics. 2015; 31: 28-35.
14. Molimard M, Buhl R, Niven R,et al. Omalizumad reduces oral corticosteroid use in patients with severe allergic asthma: real life data.Respir Med 2010;104:1381-5.
15. Vignola AM, Humbert M, Bousquet J, et al. Efficacy and tolerability of anti-immunoglobulin E therapy with omalizumab in patients with concomitant allergic asthma and persistent allergic rhinitis: SOLAR. Allergy 2004; 59:709- 17.
16. Bousquet J, Cabrera P, Berkman N, et al. The effect of treatment with omalizumab, an antiIgE antibody, on asthma exacerbations and emergency medical visits in patients with severe persistent asthma. Allergy 2005; 60:302-8.
17. Abraham I, Alhossan A, Lee CS, Kutbi H, MacDonald K. ‘Real-life’ effectiveness studies of omalizumab in adult patients with severe allergic asthma: systematic review. Allergy 2016 Allergy; 71: 593-610.
18. Korn S, Thielen A, Seyfried S, Taube C, Kornmann O,Buhl R. Omalizumab in patients with severe persistent allergic asthma in a reallife setting in Germany. Respir Med 2009; 103: 1725-31.
19. Brusselle G, Michils A, Louis R, et al. “Real-life” effectiveness of omalizumab in patients with severe persistent allergic asthma: The PERSIST study. Respir Med 2009;103: 1633-42
20. Cazzola M, Camiciottoli G, Bonavia M, et al. Italian reallife experience of omalizumab. Respir Med 2010; 104:1410-6.
21. Bavbek S, Aydın O, Kepil Ozdemir S,Yılmaz I, Celik GE, Demirel YS, et al. Therapy with omalizumab in patients with severe persistent allergic asthma: A real life data in Turkey. Tuberk Toraks 2010; 58: 425-34.
22. Ozgur ES, Ozge C, Ilvan A, Naycı SA. Assessment of long-term omalizumab treatment in patients with severe allergic asthma long-term omalizumab treatment in severe asthma. J Asthma 2013; 50: 687-94.
23. Tat TS, Cilli A. Omalizumab treatment in asthma-COPD overlap syndrome.J Asthma 2016; 53: 1048-50.
24. Effectiveness evaluation of anti-IgE treatment at 3rd year: Real life Turkey data Ayse Arzu Yorgancioglu, Ferda Öner Erkekol, Münevver Erdinç, Dilsad Mungan, Bilun Gemicioglu, Zeyn ep Ferhan Özseker, Papatya Bayrak Degirmenci, Sibel Nayci, Aykut Çilli, Füsun Erdenen, Cengiz Kirmaz, Dane Ediger, Arzu Didem Yalçin, Suna Büyüköztürk, Sami Büyüköztürk, Mustafa Güleç, Rana Isik, Ali Fuat Kalyoncu, Özlem Göksel, Ömür Aydin, Yavuz Havlucu, Idilhan Baloglu Ar, Ahmet Erdogdu European Respiratory Journal 2016 48: PA3381; DOI: 10.1183/1399300.
25. Nathan RA, Sorkness CA, Kosinski M, Schatz M,Li JT, Marcus P, Murray JJ, Pendergraft TB. Development of the asthma control test: A survey for assescing asthma control. J Allergy Clin Immunol 2004;113(1):59-65.
26. Schatz M, Zeiger RS, Drane A, et al. Reliability and predictive validity of the Asthma Control Test administered by telephone calls using speech recognition tecnology. J Allergy Clin Immunol 2007;119:336-43.
27. Marcus P.Incorporating anti-IgE (omalizumab) therapy into pulmonary medicine practice.Chest 2006;129:466-74.
28. Cox L, Platts-Mills TA, Finegold I, Schwartz LB,Simons FE, Wallace DV. American Academy of Allergy, Asthm & Immunology; American College of Allergy, Asthma and Immunology. Joint Task Force Report on omalizumab associated anaphylaxis. J Allergy Clin Immunol 2007;120(6):1373-7.
29. Zar JH. Biostatistical analysis. 2nd ed. Englewood Cliffs, N.J.: Prentice-Hall, 1984.
30. Strunk RC,Bloomberg GR. Omalizumab for asthma. N Engl J Med 2006;354:2689-95.
31. Navarro A, Valero A,Julia B, Quirce S. Coexistence of asthma and allergic rhinitis in adult patients attending allergy clinics: ONEAIR study. J Investig Allergol Clin Immunol. 2008; 18:233-8.
32. Nathan RA. Management of patients with allergic rhinitis and asthma:literatüre review.South Med J.2009;102: 935-41.
33. Corren J, Casale T, Lanier BQ, Blogg M, Reisner C, Gupta N. Omalizumab is well tolerated inadolescen /adult paitnts (12 years) with moderate-to-severe persistent asthma. J Allergy Clin Immunol 2005;115:75.
34. SandströmT.Targeting immunoglobulin E as a novel treatment for asthma. Curr Allergy Astma Rep 2005;5:109-15.
35. Sullivan SD, Rasouliyan L, Russo PA, Kamath T, Chipps BE; fort he TENOR Study Group. Extent, patterns, and burden of uncontrolled disease in severe or difficult-to-treat asthma. Allergy 2007; 62:126-33.
36. Seung SJ, Mittman N. Urgent care costs of uncontrolled asthma in Canada, 2004. Can Respir J 2005;12:435-6.
37. Santos LA, Oliveira MA, Faresin SM, Santoro LL, Fernandes ALG. Direct costs of asthma in Brazil: a comparison between controlled and uncontrolled asthmatic patients. Braz J Med Biol Res 2007;40: 943-8.
38. Accordini S, Bugiani M, Arossa W, Gerzeli S, Marinoni A, Olivieri M, et al. Poor control increases the economic cost of asthma. Int Arch Allergy Immunol 2006;141:189-98.