137 Omalizumab therapy for allergic bronchopulmonary aspergillosis patients with cystic fibrosis

Abstract

Objectives: Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) is characterized by an elevated total serum immunoglobulin E (IgE) level and the presence of IgE antibodies directed against Aspergillus fumigatus antigens. Long term treatment with oral corticosteroids can result in serious adverse effects. As a result, alternative therapies have been sought. One such therapy uses the humanized recombinant anti-IgE monoclonal antibody omalizumab. Method: Here we present the clinical profile of six children treated with omalizumab. Monthly omalizumab therapy has been used to six patients with ABPA and CF. Four patients had experienced adverse effects related to long-term use of corticosteroids and two patients had no response to steroid therapy prior to omalizumab. Results: Omalizumab treatment was related to significant reduction of Ig E (p = 0.043) and improvement in symptoms of all patients. Corticosteroids were reduced after the omalizumab initiation of one to three months later. However there were no significant difference between the radiological findings and lung function tests (FEV1%) (p = 0.68) after the treatment. The mean duration of omalizumab therapy was 9 months (3-13 months). Conclusion: Steroid-sparing effects of omalizumab have been previously reported in patients with ABPA and allergic bronchial asthma, but conflicting reports exist in the CF literature. Here; symptoms improved, FEV1 stability was achieved and clear reductions in IgE with omalizumab therapy were demonstrated. Therefore, omalizumab may be an alternative therapy for ABPA in CF patients who fail to respond to systemic corticosteroids or have serious adverse effects.