IgE-Blocking Therapy for Difficult-to-Treat Asthma: A Brief Review

Omalizumab, a novel therapy that targets specific steps in the inflammatory cascade of asthma, may benefit the hard-to-treat patient.
Gailen D. Marshall Jr., MD, PhD
University of Texas Health Science Center at Houston Medical School


Purpose. To review the characteristics of difficult-to-treat asthma and describe patients who may benefit from therapy with the recently approved humanized monoclonal anti-immunoglobulin E (IgE) antibody, omalizumab.

Principal findings. Up to 20 percent of patients have difficult-to-treat asthma. These patients consume a disproportionate share of asthma care resources. Clinical and economic outcomes can be improved via improved self-management, increased adherence to prescribed therapy, and better compliance to national asthma treatment guidelines. These patients also may benefit from therapies that directly target mechanisms responsible for persistent airway inflammation and elicit favorable clinical responses.

Conclusions. Effective asthma control remains difficult in a small cohort of patients with persistent, severe airway inflammation. Management strategies that improve asthma control and reduce exacerbations can improve clinical outcomes and minimize health care resource utilization.

Key Words: asthma, asthma management, immunoglobulin E, IgE blockers, omalizumab

Author correspondence:
Gailen D. Marshall Jr., MD, PhD
Professor and Director
Division of Allergy and Clinical Immunology
The University of Texas Health Science Center
6431 Fannin 4.202 MSB
Houston, TX 77030
Email: [email protected]

Research supported by Genentech Inc. and Novartis Pharmaceutical Corp.

This paper has undergone peer review by appropriate members of Managed Care’s Editorial Advisory Board.