From the Guidelines
Biological immunotherapy, specifically omalizumab, should be considered as an adjunctive treatment for allergic bronchopulmonary aspergillosis (ABPA) to improve symptoms, reduce exacerbations, and decrease oral steroid doses, as evidenced by recent clinical practice guidelines 1. The use of biological immunotherapies in ABPA has been explored in several studies, with a focus on monoclonal antibodies against IgE, IL-5, IL-5R, IL-4Rα, and TSLP. Key benefits of these therapies include:
- Reduction in ABPA exacerbations and asthma hospitalizations
- Improvement in lung function
- Decrease in oral steroid doses
- Improvement in symptoms Omalizumab, an anti-IgE monoclonal antibody, has been shown to be effective in ABPA patients, with improvements in symptoms, reduction in exacerbations, and decrease in oral steroid doses 1. Other biological agents, such as mepolizumab (anti-IL-5), benralizumab (anti-IL-5R), dupilumab (anti-IL-4Rα), and tezepelumab (anti-TSLP), have also been used in ABPA patients, although most experience is with omalizumab 1. In terms of treatment approach, biological immunotherapies should be considered as an adjunct to standard therapy, which includes systemic corticosteroids and antifungal therapy. The dosing and duration of biological immunotherapies may vary depending on the specific agent and patient characteristics, but omalizumab is typically administered at 300-600 mg subcutaneously every 2-4 weeks, with dosing based on weight and baseline IgE levels. The mechanisms of action of these biologics, such as binding free IgE and downregulating IgE receptors (omalizumab) or reducing eosinophil production and activation (mepolizumab), help control the hypersensitivity response to Aspergillus antigens, potentially allowing for steroid dose reduction and improved symptom control in refractory cases 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Biological Immunotherapy in Allergic Bronchopulmonary Aspergillosis
- Biological immunotherapy has been explored as a treatment option for allergic bronchopulmonary aspergillosis (ABPA) to reduce the reliance on oral corticosteroids and antifungals, which can have significant side effects with long-term use 2.
- Studies have shown that biologics targeting immunoglobulin E (IgE), eosinophils, or type 2 immune responses can be effective in treating ABPA, particularly in patients who are refractory to standard treatments 2, 3.
Specific Biologics Used in ABPA Treatment
- Omalizumab, an anti-IgE antibody, has been consistently shown to decrease co-morbid asthma exacerbation and the dose of oral corticosteroids in patients with ABPA 2, 3, 4.
- Mepolizumab and benralizumab, which target eosinophils, have also been effective in improving chest radiographic abnormalities and reducing the dose of oral corticosteroids 2.
- Dupilumab and tezepelumab may be effective in patients who are resistant to treatment with omalizumab, mepolizumab, or benralizumab, although data on these biologics is limited 2.
Safety and Efficacy of Biologics in ABPA
- The use of biologics in ABPA has been shown to be safe and effective, with no significant adverse events or worsening of infection reported in several studies 3, 4.
- Omalizumab, in particular, has been found to be effective and safe in patients with ABPA, regardless of comorbid chronic respiratory tract infections 4.