Omalizumab: a new treatment option for allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a severe complication in patients with cystic fibrosis (CF), resulting in deterioration of lung function and impairment of overall prognosis. Standard therapy consists of high dosage, long-term corticosteroid treatment. This carries the risk of serious side effects such as immune suppression, diabetes and osteoporosis. Antifungal drugs such as itraconazole may cause interactions with other drugs and drug levels need to be monitored. Omalizumab treatment has been tried in several case studies. Methods: This was a retrospective study of six patients (four female, two male, age 4-33 years old) with CF and ABPA treated with omalizumab within an observation period of 7.5 years. Results: All patients showed clinical and laboratory stability or even an improvement within the treatment and post-treatment observation period, although omalizumab therapy was less effective in patients with progressed lung disease and long-term ABPA. Side effects of systemic steroids were reduced. Conclusion: Omalizumab has the potential to be an additional and solitary treatment option in patients with CF and ABPA. Early onset treatment may be beneficial and patients with early stage of lung disease seem to benefit more.