Predicting the Clinical Response to Omalizumab With Anti-Immunoglobulin E (IgE) Ab Response or Syk Expression in Basophils

Phase 4

Completed

Brief Summary: This research is being done to test whether differences in blood cells at baseline (start of the study) can be used to predict how well omalizumab will work in a patient. Omalizumab (Xolair) is a drug approved by the U.S. Food and Drug Administration (FDA) to treat asthma. Studies show that omalizumab improves the symptoms of asthma but some people experience better improvement than others.

Detailed Description: From a therapeutic perspective, the study will determine whether changes in the peripheral blood basophil response to crosslinking anti-IgE Ab during treatment with omalizumab predicts the clinical efficacy of treatment with the drug. Secondary outcomes measures would focus on whether the starting level of anti-IgE-mediated histamine release, or the changes syk expression or its starting level would be sufficient to predict the clinical outcome.

The study is a single-site trial to evaluate the utility of baseline basophil measures to predict the efficacy of subcutaneously administered omalizumab as an add-on therapy for the treatment of adult patients 18-75 years old who have been diagnosed with moderate to severe asthma according to current approved guidelines. Patients will be treated with omalizumab according to the standard FDA approved dosing table for a period of 16 weeks.

Recruitment & Eligibility

Inclusion Criteria

Patients with moderate-to-severe asthma; male and females aged 18-75 who are symptomatic despite treatment with inhaled corticosteroids if they also had an asthma duration > 1 year.
Positive blood testing to at least one common allergen (including must mite, D. F. and D. P., cockroach, dog or cat)
Serum IgE within the bounds of the dosing table (>30 IU/ml to < 700 IU/ml)
Reversibility of > 12% within 30 minutes after administration of albuterol or history of reversibility in past or history of positive methacholine in past
Baseline Forced expiratory volume (FEV1) of > 0% and < 80% of predicted
Treatment with 400 to 800 ug day of beclomethasone dipropionate or its equivalent.
Patients must be willing to give written informed consent and be able to adhere to dose and visit schedules and meet trial requirements.
Patients will be excluded if they have prior sensitivity to omalizumab, and acute respiratory tract infection prior to or during the run-in period, or a need for regular B-agonist use.

Exclusion Criteria

Treatment with an investigational agent within 30 days of screening
Previously treated with omalizumab within a year prior to screening
Treatment 1 month prior to screening with: hydroxychloroquine, methotrexate, cyclosporine, cyclophosphamide, intravenous immunoglobulin G, and plasmapheresis
Clinically relevant laboratory anomalies at screening including individuals with reduced hematocrit (<32%), White Blood Cell (WBC) count (2400/microliter), platelet count (< 75000/microliter), and increased creatinine (> 141.4 micromolar/L), or aminotransferase (AST) (>100 IU/L).
Patients with current malignancy, history of malignancy, or currently under work-up for suspected malignancy, or bleeding disorder.
History of any medical condition that is unstable
Inability to comply with study and follow-up procedures
Patients may not take systemic corticosteroids within 2 weeks prior to screening\
Women of childbearing potential who are pregnant or nursing mothers, or who are of childbearing potential (post-menarche) and are not practicing an acceptable form of contraception ( as determined by the site investigator)
Individuals with body weight less than 30 kg or greater than 150 kg.

Arm && Interventions

Group	Intervention	Description
Omalizumab	Omalizumab	Active

Primary Outcome Measures

Name	Time	Method
Changes in the Peripheral Blood Basophil Response to Crosslinking Anti-IgE Ab	baseline and 26 weeks	Data will be analyzed for the fold change in the in vitro anti-IgE-mediated histamine release response

Secondary Outcome Measures

Name	Time	Method
Changes in Syk Expression	baseline and 26 weeks	Change in syk expression. Syk is a signaling molecule that is the first downstream event in IgE receptor activation of basophils.