Omalizumab Effectiveness in Severe Allergic Asthma with Multiple Allergic Comorbidities: A Post-Hoc Analysis of the STELLAIR Study

BACKGROUND: Immunoglobulin (Ig) E-mediated pathophysiological mechanisms are common in allergic diseases including severe allergic asthma (SAA). The anti-IgE monoclonal antibody omalizumab may be particularly beneficial for patients with SAA and multiple allergic comorbidities (AC) including perennial/seasonal rhinitis, conjunctivitis, atopic dermatitis (AD), and food allergy. METHODS: We conducted a post-hoc analysis of the patients from the STELLAIR study (n=872, 149 minors and 723 adults). The patients were classified based on the presence of multiple AC (≥3 AC or <3 AC) or AD as assessed by questionnaire. Response to omalizumab was assessed after 4–6 months (T(4–6)) and after 12 months (T(12)). Asthma response at T(4–6) was based on global evaluation of treatment effectiveness, reduction of ≥40% in annual exacerbation rate, and a combination of both. Asthma response at T(12) was based on change in yearly exacerbation and hospitalization rates. AC improvement at T(12) was based on patient perception. RESULTS: Patients with ≥3 AC demonstrated a higher combined response to omalizumab (74.7% vs 58.3%) at T(4–6) and had reduced yearly exacerbation and hospitalization rates (88.9% vs 77.4% and −94.0% vs −70.5%, respectively). Patients with ≥3 AC were more likely to show an improvement in their AC (85.3% vs 51.9%) at T(12). Results were similar in minors and adults. The presence of AD was associated with greater omalizumab effectiveness at T(4–6) and a greater AC improvement at T(12). Improvement of AD and food allergies at T(12) were 73.2% and 38.7%, respectively, in the population overall. CONCLUSION: This post-hoc analysis of the STELLAIR study shows that omalizumab is beneficial for all SAA patients and especially for patients with multiple AC or AD. In patients with ≥3 AC, omalizumab also improved AC outcomes.