Xolair (Omalizumab)

Question

My daughter, who is 43 years old and has cystic fibrosis with severe allergy has been proposed a treatment by Xolair. Can you tell me more about it? Thank you.

Answer

Hello,
Xolair is the commercial name of Omalizumab, a drug which has recently been commercialized for the treatment of severe allergic asthma, particularly when treatment with oral steroids is needed. It is an antibody which settles on immunoglobulins E (IgE), which are elevated in these allergic patients' blood. It can allow a decrease in the symptoms of asthma, and to decrease or even stop the steroid treatment. This treatment is administered by subcutaneous injections in the arms; its dose and the frequency of injections (every 2 or 4 weeks) are determined according to the patient's age (it is not allowed for children less than 12 years old), weight and IgE blood level.
Today, there is no general agreement for its use in cystic fibrosis. Nevertheless, several case reports have reported effectiveness of treatment with Omalizumab in patients with cystic fibrosis and allergic bronchopulmonary aspergillosis (ABPA). These patients have severe symptoms of asthma induced by allergy to filamentous fungi, aspergillus. They also have high blood levels of IgE and the reference treatment is oral steroids. It is likely that this treatment has been proposed to your daughter because of ABPA with symptoms of asthma in the hope to reduce her respiratory embarrassment and to taper steroids. Use of steroids is all the more a problem that it can facilitate the onset of diabetes.
Treatment with Omalizumab is prescribed on a specific prescription for "exception drugs" by a specialized physician as it is very expensive. In patients with CF in France, it is totally reimbursed, as the other treatments for CF.
I advise your daughter to ask her CF doctor for more information.
Yours sincerely.
Dr Dominique Hubert

06.12.2010