Posted 5/1/2006 10:57 AM (GMT -7)
I noticed there had been a few posts several days ago about Xolair. I was in the drug study for an anti-IgE drug over ten years ago and I believe Xolair is the result. The FDA approved it for use two summers ago. I am considered a severe, persistent, steroid-dependent asthmatic with seasonal and environmental contact allergies. My regimen consisted of Azmacort inhaler, albuterol inhaler and, whenever I got a cold it took up serious residence in my lungs requiring a course of prednisone and antibiotics to help ease the exacerbation of asthma symptoms it caused.
During the drug study all patients were weaned off their Azmacort inhaler, or at least the attempt was made. I was weaned off and steroidal inhaler free until the end of the trial. When the codes were broken the clinic notified me that I had been on a half dose of the studied drug at the time.
Fast forward to two years ago. Xolair has been approved by the FDA to treat moderate to severe persistent steroid dependent asthmatics. The drug is now administered as a subcutaneous injection (just under the skin as opposed to into a large muscle) either once or twice a month. This drug is handled only by five specialty pharmacies in the US (I don't know about outside the US) and it takes some doing to get your doc's office to coordinate with them to ship the drug. The drug has to be refrigerated and shipped that way as well. Once it is reconstituted it is only good for 8 hours. It would be very difficult to self-inject this drug IMO because it is very thick and injecting it too quickly hurts.
I have not had a course of prednisone for two years since starting this drug and have been able, by and large, to avoid antibiotic use as well. Colds seem to stay where they belong...in my sinuses...IF I get them. I did wean myself off my Pulmicort inhaler and add I it back in if I get a cold or, as now, there is a wicked pollen season going on in NH. I use far less than the prescribed dosage and wean off again when any worsening symptoms go away. This has all been done with the supervision and approval of my primary care doc.
What is an anti-IgE drug? There are a number of types of Immunoglobulin in your blood(known by letters of the alphabet), IgE is apparently the one responsible for allergic histamine response. Xolair binds itself to the IgE in your blood, essentially turning off the allergic response in the blood chemistry. Or at least that's how I understand it.
Xolair is NOT, I repeat, NOT a replacement for your rescue inhaler/nebulizer. I have exercise induced asthma as well (just for extra special fun) and use my albuterol as prevention before I hike or run with the dog.
Xolair is a genetically engineered drug and is hideously expensive. If you do not have insurance that will cover it, check with the drug company, it claims to have programs for people who cannot afford the drug.
You may have to be a very militant advocate for yourself to investigate this with your doc. His/her office staff is going to have to coordinate the initial paperwork, etc with a specialty pharmacy and then stay on top of coordinating the shipping with your visits. It is a MUST that you stay within the treatment regimen of once every 15 days (twice a month) or once every 30 days. I have discovered that if we slide my appointment by a week I experience worsening asthma symptoms.
Along with Xopenex, a drug developed by Sepracor with the express purpose of stripping out the molecules from albuterol that cause cardiac arrythmias(another drug developed beginning over a decade ago and only just approved by the FDA), Xolair is an amazing evolution in the treatment of asthma. I have experienced the change from shots of epinephrine (any wonder I'm an adrenaline junkie LOL) in the emergency room to nebulizer treatment to inhalers to this and feel lucky to have seen these changes over my lifetime. I'll be 47 this summer and have been asthmatic all my life.
Good luck and hope that answers some questions.