Impact of body mass index on omalizumab response in adults with moderate-to-severe allergic asthma

Background: Effectiveness of asthma treatment, including biologics, may be different in patients with higher body mass index (BMI). Objective: To evaluate response to omalizumab (dosed by serum immunoglobulin E level and weight) by BMI category. Methods: Pooled data from 2 randomized, double-blind, placebo-controlled studies of adults with moderate-to-severe allergic asthma were analyzed by BMI category (<25 kg/m(2) [normal or underweight], n = 397; 25 to <30 kg/m(2) [overweight], n = 330; >= 30 kg/m(2) [obese], n = 268). Placebo-adjusted exacerbation rate reductions were evaluated by Poisson regression modeling. Changes from baseline in forced expiratory volume in 1 second, beclomethasone dipropionate (BDP) dose, Total Asthma Symptom Score, and Asthma Quality of Life Questionnaire were evaluated by analysis of covariance. Results: Greater placebo-adjusted exacerbation rate reductions (95% confidence interval) were observed with increasing BMI (normal or underweight, -37.4% [-69.0% to 26.8%]; overweight, -52.7% [-78.4% to 3.7%]; obese, -71.9% [-86.9% to -39.5%]). There were no differences in forced expiratory volume in 1 second improvement between BMI categories at week 16 (normal or underweight, 76.2 [5.3-147.1] mL; overweight, 98.1 [13.9-182.4] mL; obese, 69.1 [-18.9 to 157.2] mL). No differences in BDP dose reduction (mu g) were noted between BMI categories (normal or underweight, 23.0 [15.7-30.3]; overweight, 22.5 [13.5-31.5]; obese, 16.6 [5.8-27.3]). Fewer patients in the higher BMI categories eliminated BDP use. There were trends for smaller improvements with higher BMI in Total Asthma Symptom Score (normal/underweight, -0.52 [-0.82 to -0.22]; overweight, -0.50 [-0.80 to -0.20]; obese, -0.39 [-0.77 to 0.00]) and Asthma Quality of Life Questionnaire (normal or underweight, 0.34 [0.16-0.52]; overweight, 0.34 [0.13-0.55]; obese, 0.15 [-0.08 to 0.39]). Conclusion: Omalizumab provides benefit to patients with moderate-to-severe allergic asthma, regardless of BMI. (C) 2022 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc.

Automated summary

BMI may affect the effectiveness of asthma treatment, with obese patients showing better response to omalizumab. Improvement in asthma symptoms and quality of life is less pronounced in obese patients, but there is no significant difference in forced expiratory volume in 1 second and beclomethasone dipropionate dose among different BMI categories.