Role of Omalizumab in Patients With Allergic Bronchopulmonary Aspergillosis (ABPA)

Abstract

PURPOSE: Several studies have shown that there is significant clinical improvement, better control of symptoms and reduce of oral corticosteroids and itraconazol, in patients with ABPA treated with omalizumab. The aim of the study was to determine the effect of omalizumab treatment on clinical efficacy in 6 ABPA patients. METHODS: We followed 6 cases with ABPA treated with omalizumab. Oral and inhaled corticosteroid and itraconazol doses previous and during omalizumab treatment, indication of treatment, spirometric evolution, clinical improvement and side effects, were analyzed. RESULTS: 6 patients (3 asthma and 3 cystic fibrosis) were recluted. The mean age was 40,67 years. The main purpose of treatment was reducing side effects of maintenance oral corticosteroids therapy in 3 patients, poor clinical control despite optimal treatment in 2 patients and worsening of immunodeficiency due to oral corticosteroids in 1 HIV patient. The mean treatment period was 18 months (±4). The mean prednisone dose was 19 mg daily (±6). Oral corticosteroids were discontinued in 5 patients. Mean BDP equivalent was 1550 μg (±843). 5 patients were treated with itraconazol and it was stopped in all of them. Spirometry was performed in 5 patients: initial mean FEV1% was 58,4 and after 12 months mean FEV1% was 79. ACT values improvement were observed. GETE rating was excellent in 3, good in 2 and moderate in 1 patient. 2 of them developed local erythema. CONCLUSIONS: In this case series study, all patients had positive clinical response to therapy with omalizumab, showing a good safety profile. Oral corticosteroids and itraconazol were discontinued in the majority of them.