NPC Archive Item: Corticosteroids and omalizumab▼ in asthma: NICE guidance

NOTE – This is an archive post from the NPC and has not been updated since first publication. Therefore, some hyperlinks may no longer be working.

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What is this about?
NICE has published technology appraisals covering corticosteroids for asthma in children and the place of omalizumab▼ in uncontrolled asthma.

What do they say about inhaled steroids?
NICE advises that if inhaled corticosteroids are appropriate for children aged under 12 years who have chronic asthma, the least expensive product that is suitable for the individual child should be used. If both an inhaled corticosteroid and a long-acting beta-2 agonist are needed, then a combination device that contains both medicines may be used. The decision to use a combination device should be based on the individual child and their asthma. If a combination device is chosen, the least expensive device that is suitable for the individual child should be used.

National guidance on management of asthma in children and adults is published jointly by SIGN and the BTS. This was last updated in November 2007. There is a strong emphasis in the guidance on achieving control of asthma symptoms by using inhaled corticosteroids (at safe doses – see MHRA warning) when necessary, but also on stepping down to the minimum level of treatment required for control and a good quality of life. NICE has previously advised on the choice of inhaler device in children and young people aged 5-15 years, and in children and infants aged less than 5 years.

What do they say about omalizumab▼?
Omalizumab▼ is recommended by NICE as a possible treatment for adults and young people over 12 years of age with severe persistent allergic asthma only when all of the following circumstances apply:

  • When the person’s asthma is still severe and unstable despite best efforts to control it with other asthma medicines taken as directed by their doctor.

  • When the person has stopped smoking, if their doctor feels it is appropriate.

  • When the person has allergic asthma – this should be confirmed by checking past symptoms and skin testing for allergies.

  • When the person has had at least two asthma attacks within the past year that have needed admission to hospital, or when the person has had three or more severe asthma attacks within the past year, one of which has needed admission to hospital and the other two have needed additional treatment in an accident and emergency department.

Omalizumab▼ treatment should be given along with the person’s current asthma medicines. It should be prescribed by a doctor who is experienced in asthma and allergy medicine at a specialist centre. If omalizumab▼ does not control the asthma after 16 weeks, treatment should be stopped.

NICE guidance would position omalizumab at step 4 or 5 of the SIGN/BTS guidance.

The SIGN/BTS guidance also recommends that omalizumab should be administered to patients only in a healthcare setting under direct medical supervision. This is because of the risk of anaphylaxis which may occur after the first dose, but also has occurred beyond one year after beginning regular treatment. The FDA in the USA has also advised on safety aspects of omalizumab.

A section devoted to asthma and its management is open on NPC.

Clinicians who treat people with asthma should take these technology appraisals fully into account when deciding on treatment. Omalizumab▼ is a “black triangle” drug under intensive surveillance by the MHRA. Health care professionals (and patients) are therefore requested to report all suspected adverse reactions from it to the MHRA.

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