Journal club

Predicting response to omalizumab, an anti-IgE monoclonal, in severe allergic asthma is challenging. Djukanović et al (Am J Respir Crit Care Med. 2024;210(3):288–297. doi:10.1164/rccm.202310–1730OC) conducted the SoMOSA Study, to evaluate the clinical efficacy of omalizumab and to identify advanced omics biomarkers to guide therapy. The SoMOSA study was a 1 year, open-label, real-world study enrolling 216 patients with severe, uncontrolled atopic asthma, who were on high-dose inhaled corticosteroids (with or without maintenance oral corticosteroids) with at least two exacerbations in the previous year. Early response to omalizumab was assessed using the Global Evaluation of Treatment Effectiveness (GETE) score in the first 16 weeks. Early positive response was found in 63%, and 69% experienced a≥50% reduction in exacerbations over the full treatment period. Among those receiving maintenance oral corticosteroids, 57% were able to reduce their dose by at least half. Importantly, while conventional biomarkers (blood eosinophils, fractional exhaled nitric oxide, and total IgE) did not predict the response, analysis of exhaled breath via gas chromatography–mass spectrometry and plasma lipid profiling identified a distinct panel of volatile organic compounds and lipid markers that predicted clinical improvement with high accuracy (receiver …