Omalizumab in Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Meta-Analysis

Meiling Jin; Jo A Douglass; J Stuart Elborn; Ritesh Agarwal; William J Calhoun; Slawomir Lazarewicz; Xavier Jaumont; Meng Yan

doi:10.1016/j.jaip.2022.12.012

Omalizumab in Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Meta-Analysis

J Allergy Clin Immunol Pract. 2023 Mar;11(3):896-905. doi: 10.1016/j.jaip.2022.12.012. Epub 2022 Dec 26.

Authors

Meiling Jin¹, Jo A Douglass², J Stuart Elborn³, Ritesh Agarwal⁴, William J Calhoun⁵, Slawomir Lazarewicz⁶, Xavier Jaumont⁶, Meng Yan⁶

Affiliations

¹ Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: mljin118@163.com.
² Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
³ Faculty of Medicine, Health, and Life Sciences, Queen's University, Belfast, United Kingdom.
⁴ Department of Pulmonary Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India.
⁵ Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.
⁶ Novartis Pharma AG, Basel, Switzerland.

PMID: 36581073
DOI: 10.1016/j.jaip.2022.12.012

Abstract

Background: An unmet clinical need exists in the management of treatment-refractory allergic bronchopulmonary aspergillosis (ABPA). Omalizumab has shown promising effects in case series and cohort studies; however, evidence to support its routine clinical use is lacking.

Objective: The aim of this systematic review and meta-analysis was to evaluate the clinical effectiveness and safety of omalizumab in patients with ABPA.

Methods: We conducted a systematic search across standard databases using specific key words until May 13, 2021. We performed a meta-analysis to compare the effectiveness (exacerbations, oral corticosteroid [OCS] use, lung function, and patient-reported asthma control) and safety of pre- and post-omalizumab treatment. Subgroup analyses were performed for treatment duration and underlying disease.

Results: In total, 49 studies (n = 267) were included in the qualitative synthesis and 14 case series (n = 186) in the quantitative meta-analysis. Omalizumab treatment significantly reduced the annualized exacerbation rate compared with pretreatment (mean difference, -2.09 [95% CI, -3.07 to -1.11]; P < .01). There was a reduction in OCS use (risk difference, 0.65 [95% CI, 0.46-0.84]; P < .01), an increase in termination of OCS use (risk difference, 0.53 [95% CI, 0.24-0.82]; P < .01), and a reduction in OCS dose (milligrams per day) (mean difference, -14.62 [95% CI, -19.86 to -9.39]; P < .01) in ABPA patients receiving omalizumab. Omalizumab improved FEV₁ % predicted by 11.9% (95% CI, 8.2-15.6; P < .01) and asthma control, and was well-tolerated.

Conclusions: Omalizumab treatment reduced exacerbations and OCS use, improved lung function and asthma control in patients with ABPA, and was well-tolerated. The results highlight the potential role of omalizumab in the treatment of ABPA.

Keywords: ACT score; Allergic bronchopulmonary aspergillosis; Asthma; Cystic fibrosis; Exacerbations; Lung function; Meta-analysis; Omalizumab; Oral corticosteroids.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Aspergillosis, Allergic Bronchopulmonary* / drug therapy
Asthma* / drug therapy
Cystic Fibrosis* / drug therapy
Humans
Omalizumab / therapeutic use

Substances

Omalizumab
Adrenal Cortex Hormones