The combination of omalizumab improves the safety and efficacy of
allergen immunotherapy
Abstract
Background: Allergen immunotherapy (AIT)-associated adverse
events are a major concern for the safety and efficacy of AIT.
Omalizumab is a novel anti-IgE monoclonal antibody for the treatment of
allergic diseases. At present, there is no agreement on whether
combining omalizumab with AIT could improve such conditions.
Objective: To identify the superiority of combining omalizumab
and AIT in allergic diseases. Methods: A thorough search of the
Pubmed, MEDLINE, and Cochrane Library databases was conducted to find
randomized controlled trials reporting the combination of omalizumab in
AIT. A fixed-effects model was used to estimate the safety and efficacy
with 95% confidence interval. Results: The inclusion criteria
for the meta-analysis were met by a total of 10 randomized controlled
studies (containing 871 patients). According to a pooled analysis,
individuals receiving omalizumab reported significantly fewer episodes
of severe systemic adverse reaction compared to control patients (RR
0.36, 95% CI 0.22 to 0.58). Similarly, the addition of omalizumab
significantly increased the number of patients achieving target
maintenance dose (TMD) and sustained unresponsiveness to allergen (SU)
(RR 1.33, 95% CI 1.16 to 1.48; and RR 2.55, 95%CI 1.56 to 4.17,
respectively) than the control group. Meanwhile, the improvement in
symptom severity score (MD -0.28, 95%CI -0.31 to -0.25), rescue
medicine daily means score (MD -0.12, 95%CI -0.22 to -0.09), and the
number of patients consuming epinephrine in AIT(RR 0.30, 95%CI 0.15 to
0.63)were also displayed superior to control. Conclusion:
Omalizumab can significantly enhance the safety and efficacy of AIT by
decreasing the frequency of severe systemic adverse events and
increasing TMD.