In the Original Article, Randomized Trial of Omalizumab (Anti-IgE) for Asthma in Inner-City Children, Busse et al. found the introduction of guidelines-based therapy in all children decreased the number of days per fortnight that children had asthma symptoms. Treatment with omalizumab resulted in fewer days with asthma symptoms than placebo.
Studies of inner-city children, adolescents, and young adults with asthma show that symptom control is improved and exacerbations are decreased when there is either a reduction in household exposure to allergens or aggressive implementation of guidelines-based therapy.
• How effective was omalizumab in reducing asthma exacerbations?
Adding omalizumab therapy to guideline-directed care for inner-city children, adolescents, and young adults with allergic asthma resulted in a significant and clinically meaningful decrease in asthma-related symptoms of 0.48 days per 2-week period, as compared with placebo (from 1.96 to 1.48 days), a reduction in the number of participants with at least one exacerbation (30.3% in the omalizumab group vs. 48.8% in the placebo group), fewer hospitalizations (1.5% vs. 6.3%), and a reduced need for inhaled glucocorticoids to maintain this improved level of asthma control.
• Did treatment with omalizumab reduce seasonal exacerbations?
In the control group, the average monthly rate of exacerbations in the fall and spring was almost twice the rate during the summer (9.0% and 8.1% vs. 4.6%), whereas the omalizumab group had only a small, nonsignificant, increase (4.3% and 4.2% vs. 3.3%).
Table 2. Adjusted Treatment Effect on Asthma Symptoms and Health Care Use during 48 Weeks of Follow-up.
Morning Report Questions
Q: What is the mechanism of action of omalizumab?
A: Omalizumab is a humanized monoclonal anti-IgE antibody.
Q: How was omalizumab administered?
A: Each participant in the treatment arm received subcutaneous injections of omalizumab every 2 or 4 weeks for a total of 60 weeks (15 or 30 injections).