Omalizumab, airway obstruction and remodeling

There is evidence that IgE are implicated in the development of airway remodeling and that it may be attenuated by treatment with anti-IgE omalizumab. We evaluated the effect of omalizumab on airway obstruction, assuming persistent normalization of FEV1 as a marker of remodeling amelioration. Methods - In 24 patients with severe allergic asthma and FEV1 Results - Before treatment, G1 and G2 did not differ by FEV1 (63 vs 58 %), total IgE (477 vs 290 UI/L), ACT (15 vs 17) and AE (4.4 vs 4). G1 had significantly higher FENO (73 vs 22 ppb) and eosinophils (0.854 vs 0.348 10^9/L). During treatment, there was a significant increase in ACT, and decrease in AE number in both groups, already evident after 6months. By contrast, FENO and FEV1 and improved only in G1, FEV1 remaining persistently normal, see figure. Conclusions - Our findings support the hypothesis that omalizumab attenuates airway inflammation and remodeling, acting in the first few months of therapy. This effect can be expected in patients with high FENO and eosinophilia before treatment.