Severe Allergic Asthma Clinical Trial
Official title:
Correlation Between Level of Free IgE, Total IgE, Specific IgE and FceRI Expression on Effectors Cells and the Respond to Omalizumab in Subjects With Severe Asthma. Single Arm Open Label Study
Omalizumab is an anti-IgE recombinant humanized monoclonal antibody.The efficacy and
tolerability of omalizumab have been demonstrated in patients with moderate-to-severe and
allergic (IgE-mediated) asthma. Clinical benefit with omalizumab is observed when serum free
IgE levels are reduced to 50 ng/mL or less. However, although the causal role of IgE in
allergic disease is well established, the relationship between free IgE and clinical
symptoms of asthma has not been accurately quantified. Recent study demonstrated that
omalizumab and free IgE concentrations are correlated with clinical outcomes. In non
responder to omalizumab the clinical symptoms show random fluctuations around baseline
without any tendency toward improvement despite adequate suppression of free IgE. In these
patients it may be the ratio of specific IgE to total IgE or inter-patient variability in
the expression of FceRI on effector cells that define whether the patient will respond or
not to omalizumab.
This current study is designed to evaluate the mechanisms of responsiveness to omalizumab
measuring the free IgE, specific IgE and the level of FceRI expression on the effector cell
and the correlation to clinical response.
Omalizumab represents a new therapeutic approach for IgE-mediated disease. Omalizumab is an
anti-IgE recombinant humanized monoclonal antibody designed to treat IgE-mediated disease by
reducing the concentration of free IgE antibody in subjects.
The safety, tolerability, pharmacokinetics and pharmacodynamics of single and multiple doses
of Omalizumab have now been studied in more than 2000 patients. Omalizumab compared to
placebo has been demonstrated to reduce the number of asthma exacerbations, reduce the
concomitant medication burden, improve the symptom severity and improve quality of life in
phase III studies in the treatment of patients with allergic asthma, perennial allergic
rhinitis and seasonal allergic rhinitis. For further information the reader is referred to
the investigator brochure.
Allergic (IgE-mediated) asthma is characterized by the presence of IgE antibodies against
common allergens. When allergen cross-links specific IgE bound to high-affinity IgE (FceRI)
receptors on the surface of basophils and mast cells, proinflammatory mediators are released
that trigger and perpetuate airway symptomatology. Omalizumab, an anti-IgE mAb, binds to the
Fc region of all forms of circulating IgE, regardless of IgE specificity, preventing
IgE-mediated responses, and downregulating FceRI expression on mast cells and basophils. The
efficacy and tolerability of omalizumab have been demonstrated in patients with
moderate-to-severe (IgE-mediated) asthma. Clinical benefit with omalizumab is observed when
serum free IgE levels are reduced to 50 ng/mL or less. Omalizumab dosing is based on
pretreatment total serum IgE level and body weight, and calculated using a dosing table.
Omalizumab binds to IgE to reversibly form IgG-IgE complexes. In binding, omalizumab pushes
the reaction toward the IgG-IgE complex, which is incapable of binding to IgE receptors,
thereby suppressing free IgE and reducing the clinical symptoms of allergic asthma. However,
although the causal role of IgE in allergic disease is well established, the relationship
between free IgE and clinical symptoms of asthma has not been accurately quantified. Recent
study demonstrated that omalizumab and free IgE concentrations are correlated with clinical
outcomes. In non responder to omalizumab the clinical symptoms show random fluctuations
around baseline without any tendency toward improvement despite adequate suppression of free
IgE. In these patients it may be the ratio of specific IgE to total IgE or inter-patient
variability in the expression of FceRI on effector cells that define whether the patient
will respond or not to omalizumab.
This current study is designed to evaluate the mechanisms of responsiveness to omalizumab
measuring the free IgE, specific IgE and the level of FceRI expression on the effector cell
and the correlation to clinical response.
To further characterize the patients' phenotype we will also evaluate fraction of Nitric
Oxide in expired air (FE-NO) levels and eosinophils percentage in induced sputum before and
at the end of the study.
;
Observational Model: Case Control, Time Perspective: Prospective
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT03480815 -
Nocturnal TLA for Severe Allergic Asthma After Withdrawal of Omalizumab Therapy
|
N/A |