By Dr. Larry Chiaramonte
I am pleased to see from the pages of the New England Journal of Medicine that Dr. William Busse and his team have confirmed what I had gleaned from clinical practice. Namely, that treatment with Omalizumab [Xolair] can be highly effective for inner-city patients with moderate to severe asthma. As my colleague Dr. Sam Deleon and I have both written in these pages, I am in charge of treating the “worst of the worst” asthmatics at asthma ground zero in the South Bronx. We have demonstrated significant improvement in asthma control test scores with four months of Xolair asthma treatment in forty patients two years ago, although our work was not confined to those between six and 20 years of age. Dr. Ehrlich and I, along with Dr. Janet Sullivan, medical director of Hudson Health Plan, have also written in these pages about the efficacy and cost-effectiveness of Xolair.
Dr. Busse’s massive study on 400 patients points, confirming what we had learned, demonstrates the complementary roles played by clinical practice and academic medicine. We get to see what works and what doesn’t work for limited numbers of patients in a single setting; academics study efficacy on many more patients in a number of locales with an eye to adoption by institutions and reimbursement by insurance companies. Fair enough, when the treatment in question comes to about a grand per month.
I still have a few questions about the study for Dr. Busse:
1. Is the IgE ceiling of no treatment in patients with levels over 700 valid or artificial because of limited data.
2. I have found the combination of traditional immunotherapy with Xolair to be beneficial. Can that be confirmed?
3. Young people between the ages of 6 and 20 were in the study. Can we obtain data on those under 12 years of life?
I’d like to extend my thanks to Dr. Busse for his work. I have no doubt that as Xolair comes into wider use, it will save money.