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Efficacious Use of Omalizumab in the Treatment of Cystic Fibrosis
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Diana Pham, Hoang Pham, MD 2016, BSc, BA, Ena Gaudet, RN, Shawn Aaron, MD, Stephanie Santucci, RN, William H. Yang, MD
Rationale: Cystic fibrosis (CF) is a genetic respiratory disease associated with airway obstruction and chronic lung infections. 7-9% of CF cases are complicated by allergic bronchopulmonary aspergillosis (ABPA). Few studies suggest omalizumab may be effective in CF. Here we report a 25-year old male CF patient with concomitant ABPA complicated with numerous hospitalizations and steroid side effects who responded well to omalizumab. 

Methods: A retrospective chart review was performed. Evaluation jointly occurred at The Ottawa Hospital’s CF Clinic and a tertiary care Allergy & Asthma Clinic in Ottawa. 

Results: CF was diagnosed at 5 months old. Patient had a positive skin prick to Aspergillus fumigatus and a total serum IgE of 111.7 IU/mL. Corticosteroid-induced diabetes developed at age 19.  Given his poor health and high IgE levels, a decision was made to trial omalizumab. After 8 months of omalizumab, he successfully weaned off of prednisone. After 18 months, he no longer needed insulin to treat his prednisone-induced diabetes. After 20 months, his quality of life improved. During the twelve months prior to treatment he was hospitalized 8 times, but was hospitalized only once after the first 7 months of treatment. He was considered for a double lung transplant, but after 1 year of treatment, transplantation and home oxygen were no longer indicated. 

Conclusions: Omalizumab had a dramatic steroid sparing effect, reduced hospitalizations, and O2 requirements in this CF patient with ABPA and prednisone-induced diabetes. Further prospective studies using a larger cohort are necessary to make clinical recommendations.