Novartis Pharma AG submitted its application for the European approval of Xolair (omalizumab), a novel therapy, which targets a root cause of allergic disease and offers an approach to the treatment of allergic asthma. The file, submitted to the Committee for Medicinal Products for Human Use (CHMP), is based on clinical trial experience in around 5,500 patients demonstrating Xolair's efficacy in controlling symptoms and reducing asthma exacerbations (or 'attacks'), even in patients with severe allergic asthma that is uncontrolled by existing medication, company said in a release.

Xolair is conveniently administered by subcutaneous injection every two or four weeks, and is unique in blocking the action of IgE (immunoglobulin E), the antibody responsible for triggering the cascade of symptoms in patients who suffer from allergy-induced diseases. Xolair is a humanised monoclonal antibody, which is designed to bind to the IgE circulating in the bloodstream, inhibiting the release of inflammatory chemicals that cause the symptoms of asthma. Reducing IgE levels also helps to improve inflammation of the airways, making Xolair the first non-steroidal therapy that is proven to have a major anti-inflammatory effect in allergic asthma.

Xolair was developed jointly by Novartis Pharma AG, Genentech Inc and Tanox Inc, and was approved by the US FDA in June 2003. In the US, Xolair is indicated for adults and adolescents (12 years of age and above) with moderate to severe persistent asthma who have a positive skin test or in vitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids. Xolair is also approved in Australia. In Europe the proposed indication will focus on the prevention of asthma exacerbations and control of symptoms in adults and adolescents with severe persistent allergic asthma, who remain inadequately controlled despite use of inhaled corticosteroids and long-acting beta-2 agonists, the release says.

The submission is supported by a comprehensive programme of more than 30 clinical trials demonstrating Xolair's efficacy in reducing asthma exacerbations and the need for emergency medical treatment, and improving patients' quality of life. Among them is a recently completed 28-week randomised, double-blind, placebo-controlled study in 419 adults and adolescents with inadequately-controlled severe allergic asthma, results from which will be presented at the European Respiratory Society meeting in September 2004.

Data from a clinical show that the number of asthma exacerbations was significantly lower with Xolair than with best standard care alone (1.12 and 2.86 per patient-year respectively, p <0.001), equivalent to a reduction of 60.8 per cent. Significantly more patients treated with Xolair remained exacerbation-free than those on best standard care alone (49.5 per cent [102/206] vs. 26.4 per cent [28/106], p = 0.001).

This randomised, open-label, multi-centre parallel-group study of 312 patients (aged 12-73) with poorly-controlled moderate-to-severe allergic asthma was designed to investigate Xolair's efficacy and tolerability in a 'real-life' clinical setting.

Prof. Jean Bousquet of the Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France, said, "These results confirm that this therapy has the potential to transform the way we treat patients with severe allergic asthma, who remain at risk of serious and sometimes life-threatening symptoms despite receiving the best treatment currently available. For patients with severe and uncontrolled disease, Xolair has the potential to provide a major breakthrough in treatment."

The anti-inflammatory properties of Xolair are highlighted in a further study involving 43 patients (aged 19-48) with mild-to-moderate disease, whose airways have not been modified by treatment with corticosteroids. This 16-week randomised, double-blind, placebo-controlled, multi-centre parallel-group study showed that Xolair led to a reduction in many types of cells involved in airway inflammation, especially the white blood cells called eosinophils. An increase of eosinophils in the sputum is a typical feature of asthma, and this is associated with a greater risk of exacerbation and broadly correlates with disease severity.

The study showed that the mean sputum eosinophil count decreased significantly (p <0.001) from 6.6 per cent to 1.7 per cent in the Xolair group, a reduction significantly (p 0.05) greater than with placebo (8.5 per cent to 7.0 per cent).

Allergic asthma is a chronic disorder of the airways that affects nearly 150 million people worldwide and causes more than 180,000 deaths annually. The symptoms include difficulty in breathing, wheezing, coughing, chest tightness and shortness of breath. Allergies are a contributory factor in a majority of cases of asthma. In these patients, the symptoms are triggered by contact with allergens such as pollen, house dust mites or particles of animal hair.