D3.419 - Efficacy, safety, and remission outcomes of omalizumab in elderly patients with severe allergic asthma: a subgroup analysis by age of onset

Severe allergic asthma in the elderly poses unique diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and heterogeneous disease phenotypes. Omalizumab, an anti-IgE monoclonal antibody, has demonstrated efficacy in younger populations; however, real-life data regarding its use in older adults, particularly in relation to age of asthma onset and remission outcomes, remain limited.To evaluate the clinical efficacy, safety, and remission outcomes of omalizumab in elderly patients (≥65 years) with severe allergic asthma, and to compare treatment response and remission rates between early-onset asthma (<45 years) and late-onset asthma (≥45 years) subgroups.

This retrospective observational study included 44 elderly patients treated with omalizumab for at least 12 months. Clinical parameters including Asthma Control Test (ACT) scores, systemic corticosteroid use, exacerbation and hospitalization rates, and pulmonary function (FEV₁) were evaluated pre- and post-treatment. Remission was defined as ACT ≥20, absence of exacerbations, and no maintenance oral corticosteroids. Inflammatory biomarkers (total IgE, blood eosinophils), phenotype characteristics, and adverse events were also assessed. Patients were stratified according to age of asthma onset (<45 vs ≥45 years).

Of the 44 patients included in the study, 31 (70.5%) were female, with a median age of 68 years(66–71.75).After 12 months of treatment:75% of patients showed clinical response,54.5% achieved clinical remission. Significant improvements were observed in ACT scores (median: 14 to 22, p < 0.001), FEV₁ (% predicted: 59.5% to 77.5%, p < 0.001), and reduction in oral corticosteroid use (median: 8 mg to 0 mg, p < 0.001). Remission was observed in 69.2% of early-onset and 48.4% of late-onset patients, though the difference was not statistically significant (p = 0.205).No serious adverse events were reported.

Omalizumab is an effective and well-tolerated treatment option for elderly patients with severe allergic asthma, resulting in substantial improvement in disease control and lung function, with over half of patients achieving clinical remission. While early-onset asthma patients showed a higher remission rate than late-onset cases, the difference was not statistically significant. These findings support the use of personalized biologic strategies based on age of onset and biomarker profiles in elderly asthma management.