Xolair: Package Insert / Prescribing Info

Limitations of Use:

XOLAIR is not indicated for the relief of acute bronchospasm or status asthmaticus.

Limitations of Use:

XOLAIR is not indicated for the emergency treatment of allergic reactions, including anaphylaxis.

Limitations of Use:

XOLAIR is not indicated for treatment of other forms of urticaria.

Asthma, and Chronic Rhinosinusitis with Nasal Polyps, and IgE-Mediated Food Allergy

• Determine dosage of XOLAIR by serum total IgE level (IU/mL) measured before the start of treatment, and by body weight (kg).
• For patients with asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and IgE-mediated food allergy, dosage determination should be based on the primary diagnosis for which XOLAIR is being prescribed.
• Adjust doses for significant changes in body weight during treatment.
• Refer to Tables 1 and 2 for the recommended dosage for treatment of asthma, Table 3 for treatment of CRSwNP, and Table 4 for treatment of IgE-mediated food allergy.
• Total IgE levels are elevated during treatment and remain elevated for up to one year after the discontinuation of treatment. Therefore, re-testing of IgE levels during XOLAIR treatment cannot be used as a guide for dose determination.
  • Interruptions lasting less than one year: Dose based on serum IgE levels obtained at the initial dose determination.
  • Interruptions lasting one year or more: Re-test total serum IgE levels for dose determination (Table 1 or 2 for treatment of asthma, based on the patient's age, Table 3 for treatment of CRSwNP, and Table 4 for treatment of IgE-mediated food allergy).

Chronic Spontaneous Urticaria

Dosage of XOLAIR in patients with chronic spontaneous urticaria (CSU) is not dependent on serum IgE (free or total) level or body weight [see Dosage and Administration (2.5)].

Duration of Therapy

Periodically reassess the need for continued therapy based upon the patient's disease severity and level of asthma control.

Duration of Therapy

Periodically reassess the need for continued therapy based upon the patient's disease severity and level of symptom control.

Duration of Therapy

The appropriate duration of therapy for IgE-mediated food allergy has not been evaluated. Periodically reassess the need for continued therapy.

Duration of Therapy

The appropriate duration of therapy for CSU has not been evaluated. Periodically reassess the need for continued therapy.

Selection of Patients for Self-Administration of XOLAIR Prefilled Syringe or Autoinjector

Healthcare providers should consider known risk factors for anaphylaxis to XOLAIR [see Warnings and Precautions (5.1)] and mitigation strategies when selecting patients for self-administration. Patient-specific factors including the following criteria should be considered:

1a)

Asthma, CRSwNP and CSU: Patient should have no prior history of anaphylaxis to XOLAIR or other agents, such as foods, drugs, biologics, etc.

1b)

IgE-Mediated Food Allergy: Patient should have no prior history of anaphylaxis to XOLAIR or other agents (except foods), such as drugs, biologics, etc.

2)

Patient should receive at least 3 doses of XOLAIR under the guidance of a healthcare provider with no hypersensitivity reactions

3)

Patient or caregiver is able to recognize symptoms of anaphylaxis

4)

Patient or caregiver is able to treat anaphylaxis appropriately

5)

Patient or caregiver is able to perform subcutaneous injections with XOLAIR prefilled syringe or autoinjector with proper technique according to the prescribed dosing regimen and Instructions for Use

XOLAIR Prefilled Syringe

• Adolescents 12 years of age and older: XOLAIR prefilled syringe may be self-administered under adult supervision.
• Pediatric Patients 1 to 11 years of age: XOLAIR prefilled syringe should be administered by a caregiver.

XOLAIR Autoinjector

• Adolescents 12 years of age and older: XOLAIR autoinjector may be self-administered under adult supervision. The XOLAIR autoinjectors (all doses) are intended for use only in adults and adolescents aged 12 years and older.
• Pediatric Patients 1 to 11 years of age: The XOLAIR autoinjectors (all doses) are not intended for use in pediatric patients under 12 years of age.

Administration Instructions for Prefilled Syringe and Autoinjector

• Persons with latex allergies should not handle XOLAIR prefilled syringe because the needle cap of the XOLAIR 75 mg/0.5 mL and 150 mg/mL prefilled syringes contains a derivative of natural rubber latex which may cause allergic reactions in latex sensitive individuals [see How Supplied/Storage and Handling (16)].
• Visually inspect the contents of the prefilled syringe or autoinjector for particulate matter and discoloration prior to administration. XOLAIR prefilled syringe or autoinjector solution should be clear and colorless to pale brownish yellow. Do not use the prefilled syringe or autoinjector if the medicine is cloudy, discolored, or contains particles.
• Determine the number of prefilled syringes or autoinjectors needed for patient's dosage (see Table 5). For pediatric patients 1 to 11 years of age, consideration should be given to the number of prefilled syringe injections needed and volume to be injected relative to the patient's bodyweight.
• For patients requiring more than 1 injection to complete a full dose, administer each injection at least 1 inch apart from other injection sites.
• Administer subcutaneous injection into the thigh or abdomen, avoiding the 2-inch (5 cm) area directly around the navel. The outer area of the upper arms may be used only if the injection is being given by a caregiver or healthcare provider [see Instructions for Use]. The injection may take up to 15 seconds to administer.

Adverse Reactions from Clinical Studies in Adult and Adolescent Patients 12 Years of Age and Older with Asthma

The data described below reflect XOLAIR exposure for 2076 adult and adolescent patients ages 12 and older, including 1687 patients exposed for six months and 555 exposed for one year or more, in either placebo-controlled or other controlled asthma studies. The mean age of patients receiving XOLAIR was 42 years, with 134 patients 65 years of age or older; 60% were women, and 85% Caucasian. Patients received XOLAIR 150 mg to 375 mg every 2 or 4 weeks or, for patients assigned to control groups, standard therapy with or without a placebo.

The adverse reactions most frequently resulting in clinical intervention (e.g., discontinuation of XOLAIR, or the need for concomitant medication to treat an adverse reaction) were injection site reaction (45%), viral infections (23%), upper respiratory tract infection (20%), sinusitis (16%), headache (15%), and pharyngitis (11%). These reactions were observed at similar rates in XOLAIR-treated patients and control patients.

Table 7 shows adverse reactions from four placebo-controlled asthma trials that occurred ≥1% and more frequently in adult and adolescent patients 12 years of age and older receiving XOLAIR than in those receiving placebo. Adverse reactions were classified using preferred terms from the International Medical Nomenclature (IMN) dictionary. Injection site reactions were recorded separately from the reporting of other adverse reactions.

There were no differences in the incidence of adverse reactions based on age (among patients under 65), gender or race.

Adverse Reactions from Clinical Study in Healthy Adults

Anaphylaxis: Based on spontaneous reports and an estimated exposure of about 57,300 patients from June 2003 through December 2006, the frequency of anaphylaxis attributed to XOLAIR use was estimated to be at least 0.2% of patients.

Diagnostic criteria of anaphylaxis were skin or mucosal tissue involvement, and, either airway compromise, and/or reduced blood pressure with or without associated symptoms, and a temporal relationship to XOLAIR administration with no other identifiable cause. Signs and symptoms in these reported cases included bronchospasm, hypotension, syncope, urticaria, angioedema of the throat or tongue, dyspnea, cough, chest tightness, and/or cutaneous angioedema. Pulmonary involvement was reported in 89% of the cases. Hypotension or syncope was reported in 14% of cases. Fifteen percent of the reported cases resulted in hospitalization. A previous history of anaphylaxis unrelated to XOLAIR was reported in 24% of the cases.

Of the reported cases of anaphylaxis attributed to XOLAIR, 39% occurred with the first dose, 19% occurred with the second dose, 10% occurred with the third dose, and the rest after subsequent doses. One case occurred after 39 doses (after 19 months of continuous therapy, anaphylaxis occurred when treatment was restarted following a 3-month gap). The time to onset of anaphylaxis in these cases was up to 30 minutes in 35%, greater than 30 and up to 60 minutes in 16%, greater than 60 and up to 90 minutes in 2%, greater than 90 and up to 120 minutes in 6%, greater than 2 hours and up to 6 hours in 5%, greater than 6 hours and up to 12 hours in 14%, greater than 12 hours and up to 24 hours in 8%, and greater than 24 hours and up to 4 days in 5%. In 9% of cases the times to onset were unknown.

Twenty-three patients who experienced anaphylaxis were rechallenged with XOLAIR and 18 patients had a recurrence of similar symptoms of anaphylaxis. In addition, anaphylaxis occurred upon rechallenge with XOLAIR in 4 patients who previously experienced urticaria only.

Eosinophilic Conditions: Eosinophilic conditions have been reported [see Warnings and Precautions (5.5)].

Fever, Arthralgia, and Rash: A constellation of signs and symptoms including arthritis/arthralgia, rash (urticaria or other forms), fever and lymphadenopathy similar to serum sickness have been reported in post-approval use of XOLAIR [see Warnings and Precautions (5.6)].

Hematologic: Severe thrombocytopenia has been reported.

Skin: Hair loss has been reported.

Risk Summary

A registry study of XOLAIR exposure during pregnancy showed no increase in the rate of major birth defects or miscarriage. There was an increased rate of low birth weight among registry infants compared to infants in the other cohorts, despite average gestational age at birth; however, women taking XOLAIR during pregnancy also had more severe asthma, which makes it difficult to determine whether the low birth weight is due to the drug or the disease severity [see Data]. There are risks associated with poorly or moderately controlled asthma in pregnancy [see Clinical Considerations].

Human IgG antibodies are known to cross the placental barrier; therefore, XOLAIR may be transmitted from the mother to the developing fetus.

In animal reproduction studies, no evidence of fetal harm was observed in Cynomolgus monkeys with subcutaneous doses of omalizumab up to approximately 5 times the maximum recommended human dose (MRHD) [see Data].

The estimated background risk of major birth defects and miscarriage for the indicated population(s) is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the US general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

Clinical Considerations

Data

Risk Summary

There is no information regarding the presence of omalizumab in human milk, or the effects on milk production. However, omalizumab is a human monoclonal antibody (IgG1 kappa), and immunoglobulin (IgG) is present in human milk in small amounts.

The majority of infants (80.9%, 186/230) in the pregnancy exposure registry were breastfed. Events categorized as "infections and infestations" were not significantly increased in infants who were exposed to XOLAIR through breastfeeding compared with infants who were not breastfed, or infants who were breastfed without exposure to XOLAIR.

The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for XOLAIR and any potential adverse effects on the breastfed child from omalizumab or from the underlying maternal condition.

Asthma

Safety and effectiveness of XOLAIR for moderate to severe persistent asthma who had a positive skin test or in vitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids, have been established in pediatric patients aged 6 years and older. Use of XOLAIR for this indication is supported by evidence from adequate and well-controlled studies. XOLAIR was evaluated in 2 trials in 926 (XOLAIR 624; placebo 302) pediatric patients 6 to <12 years of age with moderate to severe persistent asthma who had a positive skin test or in vitro reactivity to a perennial aeroallergen. One trial was a pivotal trial of similar design and conduct to that of adult and adolescent Asthma Trials 1 and 2. The other trial was primarily a safety study and included evaluation of efficacy as a secondary outcome. In the pivotal trial, XOLAIR-treated patients had a statistically significant reduction in the rate of exacerbations (exacerbation was defined as worsening of asthma that required treatment with systemic corticosteroids or a doubling of the baseline ICS dose) [see Clinical Studies (14.1)].

Safety and efficacy in pediatric patients with asthma below 6 years of age have not been established.

Chronic Rhinosinusitis with Nasal Polyps

Safety and effectiveness in pediatric patients with chronic rhinosinusitis with nasal polyps (CRSwNP) below 18 years of age have not been established.

IgE-Mediated Food Allergy

The safety and effectiveness of XOLAIR for the reduction of allergic reactions (Type I), including anaphylaxis, that may occur with accidental exposure to one or more foods have been established in pediatric patients aged 1 year and older with IgE-mediated food allergy. Use of XOLAIR for this indication is supported by evidence from an adequate and well-controlled study that included a total of 165 pediatric patients; 61 patients aged 1 year to less than 6 years of age and 104 patients aged 6 to less than 18 years of age. A significantly greater percentage of XOLAIR-treated patients compared to placebo-treated patients was able to consume a single dose of food (peanut, cashew, milk, egg) without dose- limiting symptoms [see Clinical Studies (14.3)].

Safety and effectiveness in pediatric patients with IgE-mediated food allergy below 1 year of age have not been established.

Chronic Spontaneous Urticaria

The safety and effectiveness of XOLAIR for chronic spontaneous urticaria (CSU) who remain symptomatic despite H1 antihistamine treatment have been established in pediatric patients aged 12 years and older. Use of XOLAIR in this population is supported by evidence from adequate and well-controlled studies. Adolescent patients with CSU were evaluated in 39 patients 12 to 17 years of age (XOLAIR 29, placebo 10) included in three randomized, placebo-controlled CSU trials. A numerical decrease in weekly itch score was observed, and adverse reactions were similar to those reported in patients 18 years and older.

Safety and effectiveness in pediatric patients with CSU below 12 years of age have not been established.

Asthma, Chronic Rhinosinusitis with Nasal Polyps, and IgE-Mediated Food Allergy

Omalizumab inhibits the binding of IgE to the high-affinity IgE receptor (FcεRI) on the surface of mast cells, basophils, and dendritic cells, resulting in FcεRI down-regulation on these cells.

In allergic asthmatics, treatment with omalizumab inhibits IgE-mediated inflammation, as evidenced by reduced blood and tissue eosinophils and reduced inflammatory mediators, including IL-4, IL-5, and IL-13.

Chronic Spontaneous Urticaria

Omalizumab binds to IgE and lowers free IgE levels. Subsequently, IgE receptors (FcεRI) on cells down-regulate. The mechanism by which these effects of omalizumab result in an improvement of chronic spontaneous urticaria (CSU) symptoms is unknown.

Asthma

In clinical studies, serum free IgE levels were reduced in a dose-dependent manner within 1 hour following the first dose and maintained between doses. Mean serum free IgE decrease was greater than 96% using recommended doses. Serum total IgE levels (i.e., bound and unbound) increased after the first dose due to the formation of omalizumab:IgE complexes, which have a slower elimination rate compared with free IgE. At 16 weeks after the first dose, average serum total IgE levels were five-fold higher compared with pre-treatment when using standard assays. After discontinuation of XOLAIR dosing, the XOLAIR-induced increase in total IgE and decrease in free IgE were reversible, with no observed rebound in IgE levels after drug washout. Total IgE levels did not return to pre-treatment levels for up to one year after discontinuation of XOLAIR.

Chronic Rhinosinusitis with Nasal Polyps

In clinical studies in chronic rhinosinusitis with nasal polyps (CRSwNP) patients, omalizumab treatment led to a reduction in serum free IgE and an increase in serum total IgE levels, similar to the observations in asthma patients. The mean total IgE concentrations at baseline were 168 IU/mL and 218 IU/mL in CRSwNP Trial 1 and 2, respectively. After repeated dosing every 2 or 4 weeks, with dosage and frequency according to Table 3, the mean predose free IgE concentrations at Week 16 were 10.0 IU/mL in CRSwNP Trial 1 and 11.7 IU/mL in CRSwNP Trial 2 and remained stable at 24 weeks of treatment. Total IgE levels in serum increased due to the formation of omalizumab-IgE complexes, which have a slower elimination rate compared with free IgE. After repeated dosing every 2 or 4 weeks, with dosage and frequency according to Table 3, mean and median predose serum total IgE levels at Week 16 were 3- to 4- fold higher compared with pre-treatment levels, and remained stable between 16 and 24 weeks of treatment.

IgE-Mediated Food Allergy

In a clinical study in patients with IgE-mediated food allergy, omalizumab treatment led to a reduction in serum free IgE and an increase in serum total IgE levels, similar to the observations in asthma patients. The mean total IgE concentration at baseline was 810 IU/mL. After repeated dosing every 2 or 4 weeks, with dosage and frequency according to Table 4, the mean pre-dose free IgE concentration at Week 16 was 10.0 IU/mL. Mean total IgE levels in serum increased about 2.4-fold due to the formation of omalizumab-IgE complexes, which have a longer half-life compared with free IgE.

Chronic Spontaneous Urticaria

In clinical studies in chronic spontaneous urticaria (CSU) patients, XOLAIR treatment led to a dose-dependent reduction of serum free IgE and an increase of serum total IgE levels, similar to the observations in asthma patients. Maximum suppression of free IgE was observed 3 days following the first subcutaneous dose. After repeat dosing once every 4 weeks, predose serum free IgE levels remained stable between 12 and 24 weeks of treatment. Total IgE levels in serum increased after the first dose due to the formation of omalizumab-IgE complexes which have a slower elimination rate compared with free IgE. After repeat dosing once every 4 weeks at 75 mg up to 300 mg, average predose serum total IgE levels at Week 12 were two- to three-fold higher compared with pre-treatment levels, and remained stable between 12 and 24 weeks of treatment. After discontinuation of XOLAIR dosing, free IgE levels increased and total IgE levels decreased towards pre-treatment levels over a 16-week follow-up period.

Specific Populations

Adult and Adolescent Patients 12 Years of Age and Older

The safety and efficacy of XOLAIR were evaluated in three randomized, double-blind, placebo-controlled, multicenter trials.

The trials enrolled patients 12 to 76 years old, with moderate to severe persistent (NHLBI criteria) asthma for at least one year, and a positive skin test reaction to a perennial aeroallergen. In all trials, XOLAIR dosing was based on body weight and baseline serum total IgE concentration. All patients were required to have a baseline IgE between 30 and 700 IU/mL and body weight not more than 150 kg. Patients were treated according to a dosing table to administer at least 0.016 mg/kg/IU (IgE/mL) of XOLAIR or a matching volume of placebo over each 4-week period. The maximum XOLAIR dose per 4 weeks was 750 mg.

In all three trials an exacerbation was defined as a worsening of asthma that required treatment with systemic corticosteroids or a doubling of the baseline ICS dose. Most exacerbations were managed in the outpatient setting and the majority were treated with systemic steroids. Hospitalization rates were not significantly different between XOLAIR and placebo-treated patients; however, the overall hospitalization rate was small. Among those patients who experienced an exacerbation, the distribution of exacerbation severity was similar between treatment groups.

Pediatric Patients 6 to <12 Years of Age

The safety and efficacy of XOLAIR in pediatric patients 6 to <12 years of age with moderate to severe asthma is based on one randomized, double-blind, placebo controlled, multi-center trial (Asthma Trial 4 [NCT00079937]) and an additional supportive study (Asthma Trial 5).

Asthma Trial 4 was a 52-week study that evaluated the safety and efficacy of XOLAIR as add-on therapy in 628 pediatric patients ages 6 to <12 years with moderate to severe asthma inadequately controlled despite the use of inhaled corticosteroids (fluticasone propionate DPI ≥200 mcg/day or equivalent) with or without other controller asthma medications. Eligible patients were those with a diagnosis of asthma >1 year, a positive skin prick test to at least one perennial aeroallergen, and a history of clinical features such as daytime and/or night-time symptoms and exacerbations within the year prior to study entry. During the first 24 weeks of treatment, steroid doses remained constant from baseline. This was followed by a 28-week period during which inhaled corticosteroid adjustment was allowed.

The primary efficacy variable was the rate of asthma exacerbations during the 24-week, fixed steroid treatment phase. An asthma exacerbation was defined as a worsening of asthma symptoms as judged clinically by the investigator, requiring doubling of the baseline inhaled corticosteroid dose for at least 3 days and/or treatment with rescue systemic (oral or IV) corticosteroids for at least 3 days. At 24 weeks, the XOLAIR group had a statistically significantly lower rate of asthma exacerbations (0.45 vs. 0.64) with an estimated rate ratio of 0.69 (95% CI: 0.53, 0.90).

The XOLAIR group also had a lower rate of asthma exacerbations compared to placebo over the full 52-week double-blind treatment period (0.78 vs. 1.36; rate ratio: 0.57; 95% CI: 0.45, 0.72). Other efficacy variables such as nocturnal symptom scores, beta-agonist use, and measures of airflow (FEV1) were not significantly different in XOLAIR-treated patients compared to placebo.

Asthma Trial 5 was a 28-week randomized, double blind, placebo-controlled study that primarily evaluated safety in 334 pediatric patients, 298 of whom were 6 to <12 years of age, with moderate to severe asthma who were well-controlled with inhaled corticosteroids (beclomethasone dipropionate 168-420 mcg/day). A 16-week steroid treatment period was followed by a 12-week steroid dose reduction period. Patients treated with XOLAIR had fewer asthma exacerbations compared to placebo during both the 16-week fixed steroid treatment period (0.18 vs. 0.32; rate ratio: 0.58; 95% CI: 0.35, 0.96) and the 28-week treatment period (0.38 vs. 0.76; rate ratio: 0.50; 95% CI: 0.36, 0.71).

Adult Patients 18 Years of Age and Older

The safety and efficacy of XOLAIR was evaluated in two, randomized, multicenter, double-blind, placebo-controlled clinical trials (CRSwNP Trial 1 [NCT03280550] and CRSwNP Trial 2 [NCT03280537]) that enrolled patients with chronic rhinosinusitis with nasal polyps (CRSwNP) with inadequate response to nasal corticosteroids (CRSwNP Trial 1, n=138; CRSwNP Trial 2, n=127). Patients received XOLAIR or placebo SC every 2 or 4 weeks, with XOLAIR dosage and frequency according to Table 3, for 24 weeks followed by a 4-week follow-up period. All patients received background nasal mometasone therapy during both the treatment period and during a 5-week run-in period. Prior to randomization, patients were required to have evidence of bilateral polyps as determined by a nasal polyp score (NPS) ≥ 5 with NPS ≥ 2 in each nostril, despite use of nasal mometasone during the run-in period. NPS was measured via endoscopy and scored (range 0-4 per nostril: 0= no polyps; 1=small polyps in the middle meatus not reaching below the inferior border of the middle turbinate; 2=polyps reaching below the lower border of the middle turbinate; 3=large polyps reaching the lower border of the inferior turbinate or polyps medial to the middle turbinate; 4=large polyps causing complete obstruction of the inferior nasal cavity) for a total NPS (range 0-8). Patients were furthermore required to have a weekly average of nasal congestion score (NCS) > 1 prior to randomization, despite use of nasal mometasone. Nasal congestion was measured by a daily assessment on a 0 to 3 point severity scale (0=none, 1=mild, 2=moderate, 3=severe). Prior sino-nasal surgery or prior systemic corticosteroid usage were not required for inclusion in the trials and sinus CT scans were not performed to evaluate for sinus opacification. Demographics and baseline characteristics, including allergic comorbidities, are described in Table 14.

The co-primary endpoints in CRSwNP Trials 1 and 2 were NPS and average daily NCS at Week 24. In both trials, patients who received XOLAIR had a statistically significant greater improvement from baseline at Week 24 in NPS and weekly average NCS, than patients who received placebo. Results from CRSwNP Trials 1 and 2 are shown in Table 15.

The greater improvements in NPS and NCS in the XOLAIR group compared to the placebo group were observed as early as the first assessment at Week 4 in both studies, as seen in Figure 1.

The mean NPS and NCS at each study week by treatment group is shown in Figure 1.

XOLAIR had statistically significant improvements on sense of smell score compared to placebo. Sense of smell was measured by a daily assessment on a 0 to 3 point severity scale (0=no symptoms, 1=mild symptoms, 2=moderate symptoms, 3=severe symptoms). The LS mean difference for change from baseline at Week 24 in sense of smell score in XOLAIR compared to placebo was -0.3 (95% CI: -0.6, -0.1) in CRSwNP Trial 1 and -0.5 (95% CI: -0.7, -0.2) in CRSwNP Trial 2.

XOLAIR had statistically significant improvements on post-nasal drip compared to placebo. The LS mean difference for change from baseline at Week 24 in post-nasal drip score in XOLAIR compared to placebo was -0.6 (95% CI: -0.8, -0.3) in CRSwNP Trial 1 and -0.5 (95% CI: -0.8, -0.3) in CRSwNP Trial 2.

XOLAIR had statistically significant improvements on runny nose compared to placebo. The LS mean difference for change from baseline at Week 24 in runny nose score in XOLAIR compared to placebo was -0.4 (95% CI: -0.7, -0.2) in CRSwNP Trial 1 and -0.6 (95% CI: -0.9, -0.4) in CRsWNP Trial 2.

In a pre-specified pooled analysis of systemic corticosteroid use during the 24-week treatment period, there was no significant reduction in systemic corticosteroid use between the treatment arms. The proportion of patients taking systemic corticosteroid in XOLAIR was 2.3% compared to 6.2% in placebo. The odds-ratio of systemic corticosteroid use with XOLAIR compared to placebo was 0.4 (95% CI: 0.1, 1.5).

There were no sino-nasal surgeries reported, in either placebo or XOLAIR arms, in either Trial.

Adult and Adolescent Patients 12 Years of Age and Older

The safety and efficacy of XOLAIR for the treatment of chronic spontaneous urticaria (CSU), previously referred to as chronic idiopathic urticaria (CIU) was assessed in two placebo-controlled, multiple-dose clinical trials of 24 weeks' duration (CSU Trial 1; n= 319, [NCT01287117]) and 12 weeks' duration (CSU Trial 2; n=322, [NCT01292473]). Patients received XOLAIR 75 mg, 150 mg, or 300 mg or placebo by SC injection every 4 weeks in addition to their baseline level of H1 antihistamine therapy for 24 or 12 weeks, followed by a 16-week washout observation period. A total of 640 patients (165 males, 475 females) were included for the efficacy analyses. Most patients were white (84%) and the median age was 42 years (range 12–72).

Disease severity was measured by a weekly urticaria activity score (UAS7, range 0–42), which is a composite of the weekly itch severity score (range 0–21) and the weekly hive count score (range 0–21). All patients were required to have a UAS7 of ≥16, and a weekly itch severity score of ≥8 for the 7 days prior to randomization, despite having used an H1 antihistamine for at least 2 weeks.

The mean weekly itch severity scores at baseline were fairly balanced across treatment groups and ranged between 13.7 and 14.5 despite use of an H1 antihistamine at an approved dose. The reported median durations of CSU at enrollment across treatment groups were between 2.5 and 3.9 years (with an overall subject-level range of 0.5 to 66.4 years).

In both CSU Trials 1 and 2, patients who received XOLAIR 150 mg or 300 mg had greater decreases from baseline in weekly itch severity scores and weekly hive count scores than placebo at Week 12. Representative results from CSU Trial 1 are shown (Table 17); similar results were observed in CSU Trial 2. The 75-mg dose did not demonstrate consistent evidence of efficacy and is not approved for use.

The mean weekly itch severity score at each study week by treatment groups is shown in Figure 2. Representative results from CSU Trial 1 are shown; similar results were observed in CSU Trial 2. The appropriate duration of therapy for CSU with XOLAIR has not been determined.

In CSU Trial 1, a larger proportion of patients treated with XOLAIR 300 mg (36%) reported no itch and no hives (UAS7=0) at Week 12 compared to patients treated with XOLAIR 150 mg (15%), XOLAIR 75 mg (12%), and placebo group (9%). Similar results were observed in CSU Trial 2.

Storage

XOLAIR prefilled syringe and autoinjector should be shipped and stored under refrigerated conditions 2°C to 8°C (36°F to 46°F) in the original carton. Protect from direct sunlight. XOLAIR prefilled syringe and autoinjector can be removed from and placed back in the refrigerator if needed. The total combined time out of the refrigerator may not be more than 2 days. Do not use if prefilled syringe or autoinjector is left at temperatures above 25°C (77°F).

Do not freeze. Do not use if the prefilled syringe or autoinjector has been frozen.

Storage

XOLAIR should be shipped at controlled ambient temperature (≤30°C [≤86°F]). Store XOLAIR under refrigerated conditions 2°C to 8°C (36°F to 46°F) in the original carton. Do not use beyond the expiration date stamped on carton.