Effects of omalizumab in severe asthmatics across ages: A real life Italian experience.
This retrospective study aimed at evaluating long-term effects of Omalizumab in elderly asthmatics in a real-life setting.



105 consecutive severe asthmatics (GINA step 4-5; mean FEV1% predicted:66 ± 15.7) treated with Omalizumab for at least 1 year (treatment mean duration 35.1 ± 21.7 months) were divided into 3 groups according to their age at Omalizumab treatment onset: 18-39, 40-64 and ≥ 65 years.



Comorbidities, number of overweight/obese subjects and patients with late-onset asthma were more frequent among older people. A similar reduction of inhaled corticosteroids dosage and SABA on-demand therapy was observed in all groups during Omalizumab treatment; a similar FEV1increased was also observed. Asthma Control Test (ACT) improved significantly (p < 0.001) in the three groups, increasing from 15 [IQR:12-18] to 24 [IQR:22-25] in younger subjects, from 14 [IQR:10-16] to 21 [IQR:20-23] in the 40-64-year-group and from 15 [IQR:12-16] to 20 [IQR:18-22] in elderly patients where improvement was lower (p = 0.039) compared to younger people. Asthma exacerbations decreased significantly after Omalizumab but the percentage of exacerbation-free patients was higher in younger people (76.9%) compared to middle aged patients (49.2%) and the elderly (29%) (p = 0.049). After Omalizumab treatment, the risk for exacerbations was lower in subjects aged 40-64 (OR = 0.284 [CI95% = 0.098-0.826], p = 0.021) and 18-39 (OR = 0.133 [CI95% = 0.026-0.678], p = 0.015), compared to elderly asthmatics. Also, a significantly reduced ACT improvement (β = -1.070; p = 0.046) passing from each age class was observed.



Omalizumab improves all asthma outcomes independently of age, although the magnitude of the effects observed in the elderly seems to be lower than in the other age groups.
Pneumologia, Ospedale Misericordia, Grosseto, Italy. Electronic address: bsposat@tin.it.
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Sposato
Istituto di Fisiologia Clinica, CNR, Pisa, Italy.
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Scalese
Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy.
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Latorre
DIMPEFINU, Unit of Pneumology and Medicine, University of Palermo, Palermo, Italy.
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Scichilone
Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy.
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Matucci
Pneumologia, Ospedale S.Corona, Pietra Ligure, Italy.
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Milanese
Clinica Otorinolaringoiatrica, Policlinico Umberto I, Università di Roma "Sapienza", Italy.
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Masieri
Allergologia e Immunologia Clinica, Ospedale Mauriziano Umberto I, Università di Torino, Italy.
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Rolla
Pneumologia Spedali Civili di Brescia, Italy.
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Steinhilber
Pneumologia, Ospedale di Macerata, Italy.
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Rosati
Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy.
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Vultaggio
Sezione di Medicina del Lavoro, Malattie Respiratorie e Tossicologia Professionale ed Ambientale, Dipartimento di Medicina, Università di Perugia, Az. Ospedaliera Santa Maria, Terni, Italy.
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Folletti
Pneumologia, AOU di Perugia, Italy.
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Baglioni
Pneumologia, Ospedale Le Scotte, Università di Siena, Italy.
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Bargagli
Pneumologia, Ospedale Misericordia, Grosseto, Italy.
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Di Tomassi
Allergologia e Immunologia Clinica, Ospedale G. Fucito, Mercato S. Severino, Salerno, Italy.
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Pio
Allergologia e Immunologia Clinica, Ospedale G. Fucito, Mercato S. Severino, Salerno, Italy.
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Pio
Pneumologia e UTIP, Ospedale "S.Donato", Arezzo, Italy.
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Maccari
Pneumologia e UTIP, Ospedale "S.Donato", Arezzo, Italy.
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Maggiorelli
Pneumologia, Ospedale Misericordia, Grosseto, Italy.
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Migliorini
Pneumologia, Ospedale di Fivizzano, Italy.
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Vignale
Pneumologia, Ospedale di Livorno, Italy.
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Pulerà
Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia, Italy.
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Carpagnano
Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia, Italy.
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Foschino Barbaro
Pneumologia, Ospedale Misericordia, Grosseto, Italy.
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Perrella
Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy.
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Paggiaro
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D015897:Comorbidity; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000187:drug effects; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D000069444:Omalizumab / Q000008:administration & dosage / Q000494:pharmacology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D061067:Antibodies, Monoclonal, Humanized; D000069444:Omalizumab; D007073:Immunoglobulin E
Age effect; Elderly; Omalizumab; Real-life; Severe asthma