title: Case series of omalizumab for allergic bronchopulmonary aspergillosis in cystic fibrosis patients.
abstract: Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF). Corticosteroids are used as first-line therapy, but relapse and adverse effects commonly occur. Case reports have suggested the efficacy of the anti-IgE recombinant humanized monoclonal antibody omalizumab. A retrospective multicenter observational French study retrieved 32 CF patients (11 children and 21 adults) who have received omalizumab for more than 3 months in the context of ABPA. Clinical characteristics, concomitant medications (inhaled and oral corticosteroids, antifungal drugs), lung function, body mass index (BMI), and serum IgE were compared at the start and during the first year of omalizumab therapy. Omalizumab-related adverse effects and costs were also evaluated. No significant difference with omalizumab could be demonstrated with regard to lung function, BMI, or the number of patients receiving oral corticosteroids. At the time of initiation of omalizumab, 56% of patients were receiving oral corticosteroids. Five patients were able to discontinue corticosteroids during follow-up and nine patients were able to reduce their daily dose. A total of 78% of the patients had received antifungal therapy at the time of the initiation of omalizumab. Treatment tolerance was good (12.5% of patients experienced side effects). The median cost of omalizumab treatment was €3,620 per patient per month. Omalizumab may represent a steroid-sparing therapy in CF patients with ABPA. A randomized-controlled trial is urgently required to provide higher level of evidence regarding the efficacy and cost-effectiveness of omalizumab in CF patients with ABPA. Pediatr Pulmonol. 2017;52:190-197. © 2016 Wiley Periodicals, Inc.
authors.affiliation: CF Adult Center, University Center Hospital Lyon-Sud, Lyon, France.
authors.forename: Raphaële
authors.initials: R
authors.lastname: Nové-Josserand
authors.affiliation: CF Adult Center, University Center Hospital Lyon-Sud, Lyon, France.
authors.forename: Soazic
authors.initials: S
authors.lastname: Grard
authors.affiliation: Department of Respiratory Disease and Adult CF Center, Cochin Hospital, AP-HP, Paris, France.
authors.forename: Lila
authors.initials: L
authors.lastname: Auzou
authors.affiliation: University Center Hospital-HFME, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Reix
authors.affiliation: Pulmonology Unit, Adult CF Center, Rangueil-Larrey University Hospital, Toulouse, France.
authors.forename: Marlène
authors.initials: M
authors.lastname: Murris-Espin
authors.affiliation: University Center Hospital-CF Pediatric Center, Toulouse, France.
authors.forename: François
authors.initials: F
authors.lastname: Brémont
authors.affiliation: Center Hospital-Pneumology Unit, Salon de Provence, France.
authors.forename: Benyebka
authors.initials: B
authors.lastname: Mammar
authors.affiliation: Hospital Renée Sabran, Giens, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mely
authors.affiliation: Department of Respiratory Disease and Adult CF Center, Cochin Hospital, AP-HP, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Hubert
authors.affiliation: CF Adult Center, University Center Hospital Lyon-Sud, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durieu
authors.affiliation: Department of Respiratory Disease and Adult CF Center, Cochin Hospital, AP-HP, Paris, France.|Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Pierre-Régis
authors.initials: PR
authors.lastname: Burgel
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D008875:Middle Aged; D000069444:Omalizumab / Q000627:therapeutic use*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018926:Anti-Allergic Agents; D000935:Antifungal Agents; D000069444:Omalizumab; D007073:Immunoglobulin E
keywords: Aspergillus fumigatus; IgE; allergic bronchopulmonary aspergillosis (ABPA); corticosteroids; cystic fibrosis; immunoglobulin E