Factors reducing omalizumab response in severe asthma

Abstract Background Despite adding Omalizumab to conventional therapy, several severe asthmatics still show poor disease control. We investigated the factors that may affect a reduced Omalizumab response in a large population of severe asthmatics. Methods 340 patients were retrospectively evaluated. FEV 1 %, FVC%, Asthma Control Test (ACT), fractional exhaled nitric oxide (FENO), possible step-downs/step-ups of concomitant therapies, exacerbations, disease control levels, ICS doses and SABA use, observed at the end of treatment, were considered as a response to Omalizumab. Results Age was an independent risk factor for a reduced response concerning FEV 1 %, FVC%, ACT and for a lower asthma control. Obesity (vs normal weight) was a determinant condition for exacerbations (OR:3.114[1.509–6.424], p  = 0.002), for a disease partial/no control (OR:2.665[1.064–6.680], p  = 0.036), for excessive SABA use (OR:4.448[1.837–10.768], p = 0.002) and for an unchanged/increased level of concomitant asthma medications. Furthermore, obesity also reduced the response in FEV 1 (β = −6.981, p  = 0.04), FVC (β = −11.689, p  = 0.014) and ACT (β = −2.585, p  = 0.027) and was associated with a higher FENO level (β = 49.045, p  = 0.040). Having at least one comorbidity was a risk factor for exacerbations (OR:1.383[1.128–1.697], p  = 0.008) and for an ACT Conclusion Age, obesity, comorbidities, smoking habits, nasal polyps, allergic poly-sensitization might reduce Omalizumab effectiveness independently to other asthma-influencing factors.