Omalizumab and severe uncontrolled asthma

The recommendations for patients with asthma that is not well-controlled are inhaled corticosteroids (ICS) and long-acting β(2)-agonists (LABAs). Many of these patients, however, continue to have inadequately controlled asthma. In a previous study (Humbert et al. Allergy 2005;60(3):309-16), it was found that the annualized rate of severe exacerbations was reduced by 29% in patients receiving omalizumab in addition to guideline-defined therapy. In a large study in 850 patients aged 12 to 75 years who had inadequately controlled asthma despite treatment with high-dose ICS plus LABAs, with or without other controllers, omalizumab reduced exaberbations by 25% over 48 weeks (Hanania et al. Ann Intern Med 2011;154: 573-8). Are you using omalizumab in patients with severe uncontrolled asthma? We want to hear about your experience.

Leukotriene Antagonists as Asthma-Controller Therapy

In the May 5, 2011, issue of the New England Journal of Medicine, Price et al. (N Engl J Med 2011; 364:1695-1707) http://www.nejm.org/doi/full/10.1056/NEJMoa1010846 report on two parallel, multicenter trials that compared the real-world effectiveness of a leukotriene-receptor antagonist (LTRA) with either an inhaled glucocorticoid being used as a first-line asthma-controller therapy, or a long-acting beta-agonist (LABA) being used as an add-on therapy in patients who were already being given inhaled glucocorticoids. The authors assigned patients to 2 years of open-label therapy. After 2 months, the efficacy of the LTRA was equivalent to the use of an inhaled glucocorticoid as first-line controller therapy and to LABA as an add-on therapy. However, equivalence after 2 years was not proven. The two groups did not show a significant difference in either rate of exacerbations or ACQ scores. Is this what you find in your practice?