A previous CADTH Common Drug Review (CDR) of the use of omalizumab for allergic asthma in 2006 led to the recommendation by the Canadian Expert Drug Advisory Committee that omalizumab not be reimbursed due to: insufficient evidence that omalizumab improves exacerbations that lead to hospitalizations, emergency room (ER) visits, or physician visits; a dearth of data for patients who fail treatment with a long-acting beta₂-agonist (LABA) in addition to an inhaled corticosteroids (ICS); and a low likelihood of being cost-effective. The current CDR review was undertaken in response to a request from the drug plans that participate in the CDR review process asking that the use of omalizumab in asthma be re-reviewed in light of the availability of new evidence. Therefore, for the current review, new clinical evidence that has become available since the CDR review in 2006 was considered for inclusion in a systematic review to assess the efficacy and harms of omalizumab in persistent allergic asthma in patients who are inadequately controlled by an ICS in combination with a LABA.

Contents

• Abbreviations
• Executive Summary
• 1. Introduction
  • 1.1. Disease Prevalence and Incidence
  • 1.2. Standards of Therapy
  • 1.3. Drug
• 2. Submission History
  • 2.1. Reasons for the Recommendation
  • 2.2. Basis of Resubmission
• 3. Objectives and Methods
  • 3.1. Objectives
  • 3.2. Methods
• 4. Results
  • 4.1. Findings from the Literature
  • 4.2. Included Studies
  • 4.3. Patient Disposition
  • 4.4. Exposure to Study Treatments
  • 4.5. Critical Appraisal
  • 4.6. Efficacy
  • 4.7. Harms
• 5. Discussion
  • 5.1. Summary of Available Evidence
  • 5.2. Interpretation of Results
  • 5.3. Potential Place in Therapy
• 6. Conclusions
• APPENDIX 1. Patient Input Summary
• APPENDIX 2. Literature Search Strategy
• APPENDIX 3. Excluded Studies
• APPENDIX 4. Detailed Outcome Data
• APPENDIX 5. Validity of Outcome Measures
• APPENDIX 6. Summary of Systemic Reviews and Observational Studies
• References

This review report was prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). In addition to CADTH staff, the review team included a clinical expert in allergy and immunology who provided input on the conduct of the review and the interpretation of findings.

Through the CADTH Common Drug Review (CDR) process, CADTH undertakes reviews of drug submissions, resubmissions, and requests for advice, and provides formulary listing recommendations to all Canadian publicly funded federal, provincial, and territorial drug plans, with the exception of Quebec.

The report contains an evidence-based clinical and/or pharmacoeconomic drug review, based on published and unpublished material, including manufacturer submissions; studies identified through independent, systematic literature searches; and patient group submissions. In accordance with CDR Update — Issue 87, manufacturers may request that confidential information be redacted from CDR Clinical and Pharmacoeconomic Review Reports.

The information in this report is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment with respect to the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this document to ensure that its contents are accurate, complete, and up-to-date as of the date of publication, CADTH does not make any guarantee to that effect. CADTH is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in the source documentation. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the information in this document or in any of the source documentation.

This document is intended for use in the context of the Canadian health care system. Other health care systems are different; the issues and information related to the subject matter of this document may be different in other jurisdictions and if used outside of Canada, it is at the user’s risk. This disclaimer and any questions or matters of any nature arising from or relating to the content or use (or misuse) of this document will be governed by and interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein, and all proceedings shall be subject to the exclusive jurisdiction of the courts of the Province of Ontario, Canada.

CADTH takes sole responsibility for the final form and content of this document, subject to the limitations noted above. The statements and conclusions in this document are those of CADTH and not of its advisory committees and reviewers. The statements, conclusions, and views expressed herein do not necessarily represent the views of Health Canada or any Canadian provincial or territorial government. Production of this document is made possible by financial contributions from Health Canada and the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Saskatchewan, and Yukon.

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