Anaphylaxis

Anaphylaxis has been reported to occur after administration of Xolair (omalizumab) in premarketing clinical trials and in postmarketing spontaneous reports. Signs and symptoms in these reported cases have included bronchospasm, hypotension, syncope, urticaria, and/or angioedema of the throat or tongue. Some of these events have been life-threatening. In premarketing clinical trials the frequency of anaphylaxis attributed to Xolair (omalizumab) use was estimated to be 0.1%. In postmarketing spontaneous reports, the frequency of anaphylaxis attributed to Xolair (omalizumab) use was estimated to be at least 0.2% of patients based on an estimated exposure of about 57,300 patients from June 2003 through December 2006. Anaphylaxis has occurred as early as after the first dose of Xolair (omalizumab) , but also has occurred beyond one year after beginning regularly scheduled treatment.

Xolair (omalizumab) should only be administered in a healthcare setting by healthcare providers prepared to manage anaphylaxis that can be life-threatening. Patients should be closely observed for an appropriate period of time after administration of Xolair (omalizumab) , taking into account the time to onset of anaphylaxis seen in premarketing clinical trials and postmarketing spontaneous reports (see ADVERSE REACTIONS). Patients should be informed of the signs and symptoms of anaphylaxis, and instructed to seek immediate medical care should signs or symptoms occur (See PRECAUTIONS, Information for Patients).

Xolair (omalizumab) should be discontinued in patients who experience a severe hypersensitivity reaction (see CONTRAINDICATIONS).

Malignancy

Malignant neoplasms were observed in 20 of 4127 (0.5%) Xolair (omalizumab) -treated patients compared with 5 of 2236 (0.2%) control patients in clinical studies of asthma and other allergic disorders. The observed malignancies in Xolair (omalizumab) -treated patients were a variety of types, with breast, non-melanoma skin, prostate, melanoma, and parotid occurring more than once, and five other types occurring once each. The majority of patients were observed for less than 1 year. The impact of longer exposure to Xolair (omalizumab) or use in patients at higher risk for malignancy (e.g., elderly, current smokers) is not known (see ADVERSE REACTIONS: Malignancy).

General

Xolair (omalizumab) has not been shown to alleviate asthma exacerbations acutely and should not be used for the treatment of acute bronchospasm or status asthmaticus.

Information for Patients

Patients should be given and instructed to read the accompanying Medication Guide before starting treatment and before each subsequent treatment. The complete text of the Medication Guide is reprinted at the end of this document.

Patients should be advised of the risk of life-threatening anaphylaxis with Xolair (omalizumab) and that there have been reports of anaphylaxis up to 4 days after administration of Xolair (omalizumab) . Xolair (omalizumab) should only be administered in a healthcare setting by healthcare providers. Patients should be closely observed following its administration. Patients should be informed of the signs and symptoms of anaphylaxis. Patients should be instructed to seek immediate medical care should such signs or symptoms occur. (See WARNINGS, Anaphylaxis).

Patients receiving Xolair (omalizumab) should be told not to decrease the dose of, or stop taking any other asthma medications unless otherwise instructed by their physician. Patients should be told that they may not see immediate improvement in their asthma after beginning Xolair (omalizumab) therapy.

Corticosteroid Reduction

Systemic or inhaled corticosteroids should not be abruptly discontinued upon initiation of Xolair (omalizumab) therapy. Decreases in corticosteroids should be performed under the direct supervision of a physician and may need to be performed gradually.

Parasitic (Helminth) Infection

In a one-year clinical trial conducted in Brazil in patients at high risk for geohelminthic infections (roundworm, hookworm, whipworm, threadworm), 53% (36/68) of omalizumab-treated patients experienced an infection, as diagnosed by standard stool examination, compared to 42% (29/69) of placebo controls. The point estimate of the odds ratio for infection was 1.96, with a 95% confidence interval (0.88, 4.36) indicating that in this study a patient who had an infection was anywhere from 0.88 to 4.36 times as likely to have received Omalizumab than a patient who did not have an infection. Response to appropriate anti-geohelminth treatment of infection as measured by stool egg counts was not different between treatment groups. Patients at high risk of geohelminth infection should be monitored for such infections while on Xolair (omalizumab) therapy. Insufficient data are available to determine the length of monitoring required for geohelminth infections after stopping Xolair (omalizumab) treatment.

Laboratory Tests

Serum total IgE levels increase following administration of Xolair (omalizumab) due to formation of Xolair:IgE complexes (see CLINICAL PHARMACOLOGY, DOSAGE AND ADMINISTRATION). Elevated serum total IgE levels may persist for up to 1 year following discontinuation of Xolair (omalizumab) . Serum total IgE levels obtained less than 1 year following discontinuation may not reflect steady state free IgE levels and should not be used to reassess the dosing regimen.

Carcinogenesis, Mutagenesis, Impairment of Fertility

No long-term studies have been performed in animals to evaluate the carcinogenic potential of Xolair (omalizumab) .

No evidence of mutagenic activity was observed in Ames tests using six different strains of bacteria with and without metabolic activation at Omalizumab concentrations up to 5000 µg/mL.

The effects of Omalizumab on male and female fertility have been assessed in cynomolgus monkey studies. Administration of Omalizumab at doses up to and including 75 mg/kg/week did not elicit reproductive toxicity in male cynomolgus monkeys and did not inhibit reproductive capability, including implantation, in female cynomolgus monkeys. These doses provide a 2- to 16-fold safety factor based on total dose and 2- to 5-fold safety factor based on AUC over the range of adult clinical doses.

Pregnancy (Category B)

Reproduction studies in cynomolgus monkeys have been conducted with Omalizumab. Subcutaneous doses up to 75 mg/kg (12-fold the maximum clinical dose) of Omalizumab did not elicit maternal toxicity, embryotoxicity, or teratogenicity when administered throughout organogenesis and did not elicit adverse effects on fetal or neonatal growth when administered throughout late gestation, delivery, and nursing.

IgG molecules are known to cross the placental barrier. There are no adequate and well-controlled studies of Xolair (omalizumab) in pregnant women. Because animal reproduction studies are not always predictive of human response, Xolair (omalizumab) should be used during pregnancy only if clearly needed.

Pregnancy Exposure Registry

To monitor outcomes of pregnant women exposed to Xolair (omalizumab) , including women who are exposed to at least one dose of Xolair (omalizumab) within 8 weeks prior to conception or any time during pregnancy, a pregnancy exposure registry has been established. Healthcare providers should encourage their patients to call 1-866-4XOLAIR (omalizumab) (1-866-496-5247) to enroll in the Xolair (omalizumab) Pregnancy Exposure Registry. Healthcare providers can call this number to obtain further information about this registry.

Nursing Mothers

The excretion of Omalizumab in milk was evaluated in female cynomolgus monkeys receiving SC doses of 75 mg/kg/week. Neonatal plasma levels of Omalizumab after in utero exposure and 28 days of nursing were between 11% and 94% of the maternal plasma level. Milk levels of Omalizumab were 1.5% of maternal blood concentration. While Xolair (omalizumab) presence in human milk has not been studied, IgG is excreted in human milk and therefore it is expected that Xolair (omalizumab) will be present in human milk. The potential for Xolair (omalizumab) absorption or harm to the infant are unknown; caution should be exercised when administering Xolair (omalizumab) to a nursing woman.

Pediatric Use

Safety and effectiveness in pediatric patients below the age of 12 have not been established.

Geriatric Use

In clinical trials 134 patients 65 years of age or older were treated with Xolair (omalizumab) . Although there were no apparent age-related differences observed in these studies, the number of patients aged 65 and over is not sufficient to determine whether they respond differently from younger patients.

Last reviewed on RxList: 7/24/2007
This monograph has been modified to include the generic and brand name in many instances.