Clinicians not following recommendations on use of Xolair

ATLANTA — The first-ever utilization trends survey regarding Xolair — the first biologic drug approved for asthma treatment — found that work must be done to fine-tune the patient selection for the drug, according to findings presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology.

“Many patients who started [Xolair (omalizumab, Genentech, Novartis)] did not have adequate treatment with other asthma medications first, making it important to assess for adherence to other medications, especially inhaled corticosteroids, in the context of considering omalizumab,” Matthew A. Rank, MD, FAAAAI, department of allergy, asthma and immunology, Mayo Clinic, Scottsdale, Arizona, told Healio Family Medicine. “This is surprising because so few patients with asthma take omalizumab; we would have expected this group to be selected very carefully for having had tried lots of other treatments first (and failed).”

Matthew A. Rank

For their study, Rank and colleagues identified 8,545 omalizumab users from 2003 to 2015 through the OptumLabs Data Warehouse. According to the researchers, this is less than 1% of patients with asthma. Of the 8,545 users, 72% were white, 11% were black, 9% were Hispanic, 5% had an unknown race or ethnicity, 3% were Asian; in addition, 64% were female.

They found that the rate of patients with asthma using omalizumab reached its first peak in 2005, 2 years after it was approved by the FDA, at 9.56 users per 100,000 insured people. Treatment with omalizumab tapered off to 5.22 new users per 100,000 insured people by 2012, then rebounded to 12.13 new users per 100,000 insured people in 2015. In addition, 59% of those who started omalizumab used it for a less than year, 15% used it for more than 5 years, 14% used it for 1 to 2 years, 7% used it for 2 to 3 years, 3% used it for 3 to 4 years, and 2% used it for 4 to 5 years.

“It is important to say that as part of this study we did not test any solutions to improve patient selection for omalizumab. Instead, we identified what we think is a problem. The solutions are unlikely to be easy, as evidenced by our trend analysis of 13 years of omalizumab use showing no real change in how patients were selected. In other words, the current system didn’t ‘learn’ in 13 years how to improve selection,” Rank told Healio Family Medicine. “Likely, we will need to re-think how decisions for using omalizumab are made, from who is identifying patients and which criteria we as doctors/advanced practitioners are using, who decides on insurance coverage for omalizumab and which criteria are used, and how we can use already existing data sources to help inform both groups of decision-makers.”

Last July, the FDA expanded the use of omalizumab for allergic asthma in younger children. Other research has shown the drug reduced cold symptoms among children with allergic asthma. – by Janel Miller

References:

Pelalia G, et al. Nature. 2009: doi:10.1038/nrd3792

Rank MA., et al. Abstract 285. Presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting; March 3-6, 2017; Atlanta.

Disclosure: Rank reports no relevant disclosures. Healio Family Medicine was unable to confirm the other researchers’ disclosures prior to publication.