Long-term omalizumab treatment outcomes in patients with allergic bronchopulmonary aspergillosis

Abstract

Background: Omalizumab has been a valuable option for patients with severe asthma, with increasing data with regard to the effectiveness of omalizumab in patients with allergic bronchopulmonary aspergillosis (ABPA). Objective: The objective was to evaluate the long-term clinical and functional effectiveness of omalizumab in patients with ABPA. Methods: Patients who received omalizumab for ABPA in our clinic between December 2008 and September 2023 were retrospectively evaluated. Data were assessed before the initiation of omalizumab, at the first year of treatment, and at the last visits of the patients. Patients with Asthma Control Test (ACT) scores of ≥20, no hospitalization/emergency admissions due to asthma, a reduced daily oral corticosteroid (OCS) dose, and an increase in forced expiratory volume in 1 second (FEV₁) level were considered as complete responders. Results: A total of 22 patients (no. men/women: 11/11) with ABPA and with a mean age of 53 ± 14.94 years (minimum 27 years, maximum 77 years) were included in the study. Significant increases were observed in FEV₁ measured at the first year and last visit compared with pretreatment (p = 0.007). In patients who received a mean ± standard deviation (SD) of 12.73 ± 8.87 mg of methylprednisolone before treatment, the OCS dose decreased to a mean ± SD of 2.45 ± 3.08 mg of methylprednisolone in the first year and a mean ± SD of 0.36 ± 1 mg of methylprednisolone at the last visit (p < 0.001). Of 22 patients, 21 were treated with OCS, whereas 1 patient refused to use OCS due to corticophobia. The mean ± SD ACT score was 17.50 ± 4.77 (minimum 7, maximum 24) at baseline, increased to 22.23 ± 2.44 (minimum 18, maximum 25) at the first year (p < 0.001), and 23.73 ± 1.88 (minimum 19, maximum 25) at the last visit. A significant decrease in asthma attacks and hospitalizations at the first year and last visit after omalizumab treatment was observed (p < 0.001). Nineteen patients (86.3%) responded completely, and three (13.7%) responded partially to omalizumab treatment. Conclusion: Omalizumab treatment in patients with ABPA resulted in a significant reduction in asthma attacks, hospitalizations, and OCS doses, and in significant increases in FEV₁ and ACT scores.