From the Guidelines
Xolair (omalizumab) is not recommended as a primary treatment for allergic bronchopulmonary aspergillosis (ABPA) based on the most recent and highest quality evidence available 1.
Treatment Overview
The treatment of ABPA primarily involves the use of systemic glucocorticoids and oral antifungal triazoles, with the goal of reducing symptoms, improving lung function, and preventing exacerbations.
- Glucocorticoids, such as prednisolone, are the most effective treatment for acute ABPA, with dosing protocols varying based on the severity of the disease and the patient's response to treatment 1.
- Oral antifungal triazoles, especially itraconazole, have similar effects to glucocorticoids but with a slower trajectory to improvement and a better safety profile 1.
Role of Xolair in ABPA
While Xolair (omalizumab) has been used as an add-on therapy for patients with ABPA who have an inadequate response to conventional treatments, there is limited evidence to support its use as a primary treatment for ABPA.
- Xolair works by binding to circulating IgE antibodies, preventing them from attaching to mast cells and basophils, thereby reducing the allergic inflammatory response that characterizes ABPA.
- However, the most recent guidelines do not recommend Xolair as a first-line treatment for ABPA, instead focusing on the use of glucocorticoids and antifungal medications as the primary treatment approach 1.
Conclusion Not Applicable - Direct Answer Only
In summary, the primary treatment for ABPA should focus on glucocorticoids and antifungal medications, with Xolair considered only in specific cases where conventional treatments have failed, and under the guidance of a healthcare professional.
From the Research
Efficacy of Xolair in ABPA
- Xolair (omalizumab) has been shown to be effective in reducing exacerbation rates, improving symptoms, and decreasing oral corticosteroid doses in patients with severe asthma, including those with allergic bronchopulmonary aspergillosis (ABPA) 2, 3, 4.
- A study analyzing data from the Australian Xolair Registry found that patients with ABPA who received omalizumab demonstrated significant improvements in asthma control and exacerbation frequency over a 24-month period 2.
- Another study found that omalizumab was effective and safe in patients with ABPA, regardless of comorbid chronic respiratory tract infections, and reduced the frequency of exacerbations and systemic corticosteroid doses while improving pulmonary function 3.
- A synthesis review of published literature on the use of omalizumab in ABPA found that treatment with omalizumab provided a clinically important reduction in serum IgE, exacerbation rates, and steroid requirement, and showed attenuated asthma symptoms and improved pulmonary function parameters in patients with ABPA 4.
Safety and Tolerability
- The studies found that omalizumab was well-tolerated and safe in patients with ABPA, with no significant adverse events or worsening of infection during treatment 2, 3.
- The most common adverse event reported was injection-site reactions 3.
Limitations
- The current evidence is based on observational studies, case reports, and synthesis reviews, and double-blind, randomized, placebo-controlled trials are necessary to establish the efficacy and safety of omalizumab in ABPA patients 4.