Omalizumab

Identification

Summary

Omalizumab is a monoclonal anti-immunoglobulin E antibody used in the treatment of severe asthma and chronic idiopathic urticaria.

Brand Names
Xolair
Generic Name
Omalizumab
DrugBank Accession Number
DB00043
Background

Omalizumab, manufactured by Genentech, was first FDA approved in 2003 to treat adults and children 12 years of age and older with moderate to severe persistent allergic asthma which is not controlled by inhaled steroids 6. Since its U.S. approval, more than 200,000 patients older than 12 with allergic asthma have been treated 6. In September 2018, a new prefilled syringe formulation of this drug was approved by the FDA 7.

Type
Biotech
Groups
Approved, Investigational
Biologic Classification
Protein Based Therapies
Monoclonal antibody (mAb)
Protein Structure
Protein Chemical Formula
C6450H9916N1714O2023S38
Protein Average Weight
149000.0 Da
Sequences
>Omalizumab heavy chain
EVQLVESGGGLVQPGGSLRLSCAVSGYSITSGYSWNWIRQAPGKGLEWVASITYDGSTNY
ADSVKGRFTISRDDSKNTFYLQMNSLRAEDTAVYYCARGSHYFGHWHFAVWGQGTLVTVS
SGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLY
SLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKAEPKSCDKTHTCPPCPAPELLGGPSV
FLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTY
RVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTK
NQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQG
NVFSCSVMHEALHNHYTQKSLSLSPGK
>Omalizumab light chain
DIQLTQSPSSLSASVGDRVTITCRASQSVDYDGDSYMNWYQQKPGKAPKLLIYAASYLES
GVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQSHEDPYTFGQGTKVEIKRTVAAPSVF
IFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLS
STLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNR
Download FASTA Format
Synonyms
  • Omalizumab

Pharmacology

Indication

This drug is an anti-IgE antibody indicated for:

  1. Moderate to severe persistent asthma in patients 6 years of age and older with a positive skin test or in vitro reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with inhaled corticosteroids Label

  2. Chronic idiopathic urticaria in adults and adolescents 12 years of age and older who remain symptomatic despite H1 antihistamine treatment Label

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Associated Conditions
Indication TypeIndicationCombined Product DetailsApproval LevelAge GroupPatient CharacteristicsDose Form
Management ofChronic idiopathic urticaria••••••••••••••••••••••• ••••••• •• ••••••••••••• •••••••••
Management ofModerate asthma•••••••••••••••••••• •••••••••••• •••••••••• •••• ••••••• ••••••••••••••••••••••••• ••••••••
Management ofSevere asthma•••••••••••••••••••• •••••••••••• •••••••••• •••• ••••••• •••••••••••••••
Contraindications & Blackbox Warnings
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Pharmacodynamics

Omalizumab is a recombinant, humanized, monoclonal antibody against human immunoglobulin E (IgE) which treats the symptoms of asthma and chronic idiopathic urticaria by limiting the allergic response Label, 3. It inhibits the binding of IgE to receptors on mast cells and basophils, blocking the IgE-mediated secretion of inflammatory mediators from these cells 1.

Mast cell activation and the release of mediators, in response to allergen exposure and IgE, results in a cascade of events. This cascade culminates in the activation of B-lymphocytes, T-lymphocytes, eosinophils, fibroblasts, smooth muscle cells, and the endothelium. This cellular interaction, as well as the release of cytokines, chemokines and growth factors and inflammatory remodeling of the airway results in chronic asthma 2.

After 4 weeks of use of this medication in patients with chronic urticaria, it was found that rescue medication use was reduced significantly and quality of life improved 4.

Mechanism of action

When an environmental allergen first enters the body, is taken up by antigen-presenting cells (APCs). It is then processed, and presented to T and B immune cells. This is followed by the activation of B-lymphocyte and production of allergen-specific IgE. This IgE is then released by plasma cells (converted B lymphocytes) and is therefore available to bind to IgE receptors on several other cells 3.

IgE binds to high-affinity (Fc€RI) and low-affinity (Fc€RII) receptors on multiple cells of the immune system. Following subsequent antigen exposure, cross-linking of the antigen occurs by several Fc€RI-bound IgE molecules on the surface of both basophils and mast cells. This leads to the activation of mast cells and histamine release, producing a wheal and other symptoms of urticaria 3.

The following are explanations of the mechanism of action for both indications of this drug:

Asthma

Omalizumab inhibits the binding of IgE to the high-affinity IgE receptor (FcεRI) on the surface of both mast cells and basophils. The reduction in surface-bound IgE on FcεRI-bearing cells limits the degree of release of mediators of the typical allergic response. Treatment with omalizumab also reduces the number of FcεRI receptors on basophils in atopic patients Label.

Omalizumab binds to free IgE with a higher affinity than IgE itself binds to the high-affinity Fc€RI receptors found on basophils. Therefore, it decreases the availability of free IgE for binding 3. Omalizumab by itself does not bind to the Fc€RI receptors, nor does the drug bind to receptor-bound IgE. These binding characteristics allow omalizumab to neutralize the typical IgE-mediated responses without causing the degranulation of basophils or cross-linking with basophil-bound IgE 3.

Chronic Idiopathic Urticaria Omalizumab binds to IgE and decreases free IgE levels. Subsequently, IgE receptors (FcεRI) on cells are down-regulated. The mechanism by which these effects of omalizumab result in an improvement of CIU symptoms is unclearLabel.

TargetActionsOrganism
AHigh affinity immunoglobulin epsilon receptor subunit alpha
inhibitor
Humans
AHigh affinity immunoglobulin epsilon receptor subunit beta
inhibitor
Humans
Absorption

After subcutaneous administration in pharmacokinetic studies, omalizumab was absorbed with a mean absolute bioavailability of 62% Label. After the administration of a single subcutanous dose in adult and adolescent patients with asthma, omalizumab was absorbed slowly. The peak serum concentrations peaked after an average of 7­-8 days. In patients with CIU, the peak serum concentration was reached at a similar time after a single SC dose. The pharmacokinetics of omalizumab was linear at doses which were higher than 0.5 mg/kg. In patients with asthma, after several doses of omalizumab, areas under the serum concentration-time curve from Day 0 to Day 14 at steady state were up to 6-fold of those after one dose. In patients with CIU, omalizumab showed linear pharmacokinetics in the dose range of 75 mg to 600 mg administered as a single subcutaneous dose. After repeated dosing from 75mg-300 mg every 4 weeks, trough serum concentrations of omalizumab increased proportionally with the dose Label.

Volume of distribution

The apparent volume of distribution of omalizumab in patients with asthma after subcutaneous administration was 78 ± 32 mL/kg. In patients with CIU, the distribution of omalizumab was similar to that in asthmatic patients Label.

Protein binding

Monoclonal antibodies are usually not required to have protein binding studies.

Metabolism

Monoclonal antibodies, in general, are believed to be internalized in endothelial cells bound to the Fc receptor and rescued from metabolism by recycling. At a later time, they are degraded in the reticuloendothelial system to smaller peptides and amino acids, which can then be used for de-novo protein synthesis 5. Several factors may influence this process, however. These include factors related to the target antigen, antibody, and patient 5.

The metabolism of omalizumab is determined by its IgG1 framework, and by its specific binding to IgE. The elimination of omalizumab is dose-dependent. The reticuloendothelial system and the liver are two sites of elimination for IgG (including degradation in the liver reticuloendothelial system and endothelial cells) 9, 5. The omalizumab:IgE complexes are thought to be to cleared via interactions with Fc- gamma-Rs (Fc gamma RI, Fc gamma RII, and Fc gamma RIII) at rates that are more rapid than that of IgG clearance. The relative clearance of free omalizumab, free IgE, and complexes is summarized as: free IgE clearance > > omalizumab:IgE clearance > omalizumab clearance 9.

Route of elimination

Liver elimination of IgG includes degradation in the liver reticuloendothelial system (RES) and endothelial cells. Intact IgG was also shown to be excreted in bile, in pharmacokinetic studies Label.

Half-life

In chronic idiopathic urticaria (CIU) patients, at steady state, based on population pharmacokinetics, omalizumab serum elimination half-life averaged 24 days Label.

In asthmatic patients omalizumab serum elimination half-life averaged 26 days Label.

Clearance

In pharmacokinetic studies, the clearance of omalizumab involved IgG clearance as well as clearance by specific binding and complex formation with its target ligand, IgE Label, 9.

The apparent clearance averaging 2.4 ± 1.1 mL/kg/day was measured in asthmatic patients Label.

In chronic idiopathic urticaria (CIU) patients, at steady state, based on population pharmacokinetics, omalizumab apparent clearance averaged 240 mL/day (corresponding to 3.0 mL/kg/day for an 80 kg patient)Label.

Adverse Effects
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Toxicity

Anaphylaxis

Anaphylaxis may occur rarely with this agent, either after the first dose or multiple doses Label, 2. Anaphylaxis presenting clinically as bronchospasm, hypotension, syncope, urticaria, and/or angioedema of the throat or tongue, has been reported during and after this use of this drug. Therefore, close clinical monitoring should be performed during and shortly after administration Label.

Maximum Dosage

The maximum tolerated dosage of omalizumab has not yet been determined. Single intravenous (IV) doses of up to 4000 mg have been administered to patients without evidence of dose-limiting toxicity. The highest cumulative dose administered to patients was 44,000 mg over a 20 week time period, which was not associated with any toxicities Label.

The use in Pregnancy

The data with omalizumab use in pregnant women are insufficient to inform on drug-associated risk. Monoclonal antibodies, such as omalizumab, are transported across the placenta in a linear fashion as a pregnancy progresses; therefore, potential effects on a fetus are likely to be greater in frequency during the second and third trimesters Label.

In women with inadequately or moderately controlled asthma, the current evidence suggests that there is an increased risk of preeclampsia in the mother and prematurity, low birth weight, and small fetal size Label.

The use During Breastfeeding

There is no information regarding the presence of omalizumab in human milk, the effects on the breastfed infant, or the effects on milk production Label. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for omalizumab and any potential adverse effects on the breastfed child from omalizumab or from the underlying maternal condition Label.

Pathways
Not Available
Pharmacogenomic Effects/ADRs Browse all" title="About SNP Mediated Effects/ADRs" id="snp-actions-info" class="drug-info-popup" href="javascript:void(0);">
Not Available

Interactions

Drug Interactions Learn More" title="About Drug Interactions" id="structured-interactions-info" class="drug-info-popup" href="javascript:void(0);">
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
DrugInteraction
AbciximabThe risk or severity of adverse effects can be increased when Omalizumab is combined with Abciximab.
AdalimumabThe risk or severity of adverse effects can be increased when Omalizumab is combined with Adalimumab.
AducanumabThe risk or severity of adverse effects can be increased when Omalizumab is combined with Aducanumab.
AlemtuzumabThe risk or severity of adverse effects can be increased when Omalizumab is combined with Alemtuzumab.
AlirocumabThe risk or severity of adverse effects can be increased when Omalizumab is combined with Alirocumab.
Food Interactions
No interactions found.

Products

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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
XolairSolution150 mg / mLSubcutaneousNovartis2017-07-06Not applicableCanada flag
XolairInjection, solution300 mgSubcutaneousNovartis Europharm Limited2023-11-28Not applicableEU flag
XolairInjection, solution150 mgSubcutaneousNovartis Europharm Limited2023-11-28Not applicableEU flag
XolairInjection, solution300 mgSubcutaneousNovartis Europharm Limited2023-11-28Not applicableEU flag
XolairInjection, solution75 mgSubcutaneousNovartis Europharm Limited2023-11-28Not applicableEU flag

Categories

ATC Codes
R03DX05 — Omalizumab
Drug Categories
Chemical TaxonomyProvided by Classyfire
Description
Not Available
Kingdom
Organic Compounds
Super Class
Organic Acids
Class
Carboxylic Acids and Derivatives
Sub Class
Amino Acids, Peptides, and Analogues
Direct Parent
Peptides
Alternative Parents
Not Available
Substituents
Not Available
Molecular Framework
Not Available
External Descriptors
Not Available
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
2P471X1Z11
CAS number
242138-07-4

References

General References
  1. Jensen RK, Plum M, Tjerrild L, Jakob T, Spillner E, Andersen GR: Structure of the omalizumab Fab. Acta Crystallogr F Struct Biol Commun. 2015 Apr;71(Pt 4):419-26. doi: 10.1107/S2053230X15004100. Epub 2015 Mar 20. [Article]
  2. Miller CW, Krishnaswamy N, Johnston C, Krishnaswamy G: Severe asthma and the omalizumab option. Clin Mol Allergy. 2008 May 20;6:4. doi: 10.1186/1476-7961-6-4. [Article]
  3. Godse K, Mehta A, Patil S, Gautam M, Nadkarni N: Omalizumab-A Review. Indian J Dermatol. 2015 Jul-Aug;60(4):381-4. doi: 10.4103/0019-5154.160490. [Article]
  4. Kaplan AP, Joseph K, Maykut RJ, Geba GP, Zeldin RK: Treatment of chronic autoimmune urticaria with omalizumab. J Allergy Clin Immunol. 2008 Sep;122(3):569-73. doi: 10.1016/j.jaci.2008.07.006. [Article]
  5. Tabrizi MA, Tseng CM, Roskos LK: Elimination mechanisms of therapeutic monoclonal antibodies. Drug Discov Today. 2006 Jan;11(1-2):81-8. doi: 10.1016/S1359-6446(05)03638-X. [Article]
  6. FDA Approves Genentech’s Xolair® (omalizumab) for Allergic Asthma in Children [Link]
  7. FDA Approves Genentech's Xolair (omalizumab) Prefilled Syringe Formulation [Link]
  8. Omalizumab properties, THPdb Database [Link]
  9. Xolair EMA label [File]
UniProt
P01857
Genbank
J00228
PubChem Substance
46507002
RxNav
302379
ChEMBL
CHEMBL1201589
Therapeutic Targets Database
DAP000387
PharmGKB
PA164752253
RxList
RxList Drug Page
Drugs.com
Drugs.com Drug Page
Wikipedia
Omalizumab
MSDS
Download (582 KB)

Clinical Trials

Clinical Trials Learn More" title="About Clinical Trials" id="clinical-trials-info" class="drug-info-popup" href="javascript:void(0);">
PhaseStatusPurposeConditionsCount
4CompletedNot AvailableAtopic Dermatitis1
4CompletedBasic ScienceAsthma1
4CompletedDiagnosticAsthma, Allergic1
4CompletedTreatmentAllergic Rhinitis (AR) / Asthma / Atopic Dermatitis1
4CompletedTreatmentAspirin Sensitivity1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
  • Genentech Inc.
  • Novartis AG
Dosage Forms
FormRouteStrength
InjectionSubcutaneous150 MG
Injection, powder, for solutionSubcutaneous150 MG
Injection, powder, for solutionSubcutaneous75 MG
Injection, solutionParenteral; Subcutaneous150 MG
Injection, solutionParenteral; Subcutaneous75 MG
Injection, solutionSubcutaneous150 mg/1.2mL
Injection, solutionSubcutaneous300 mg
Injection, solutionSubcutaneous300 mg/2mL
Injection, solutionSubcutaneous75 mg
Powder150 mg/1vial
Powder, for solutionSubcutaneous150 mg / vial
SolutionSubcutaneous150 mg / mL
SolutionSubcutaneous75 mg / 0.5 mL
SolutionSubcutaneous75.000 mg
SolutionSubcutaneous150 mg
SolutionSubcutaneous75 mg
Injection, solutionSubcutaneous150 mg
Injection, solutionSubcutaneous150 mg/ml
Injection, powder, lyophilized, for solutionSubcutaneous150 mg
Injection, powder, for solutionSubcutaneous
Injection, powder, lyophilized, for solutionSubcutaneous75 mg
Injection, solutionSubcutaneous150 mg/1mL
Injection, solutionSubcutaneous75 mg/0.5mL
Injection, solutionSubcutaneous150 mg/1.0mL
Prices
Unit descriptionCostUnit
Xolair 150 mg vial715.42USD vial
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)Region
CA2113813No2005-04-122012-08-14Canada flag
CA1340233No1998-12-152015-12-15Canada flag

Properties

State
Solid
Experimental Properties
PropertyValueSource
melting point (°C)61 °C (FAB fragment)http://crdd.osdd.net/raghava/thpdb/display_thppid_sub.php?details=Th1038
boiling point (°C)Fab and Fc domains denaturates at 60 and 70 ºC respectivelyArnoldus W. et al. (2000). Biophysical Journal. Vol 78. 394-404
hydrophobicity-0.432Not Available
isoelectric point6.6 - 7.2Jin, et al. Electrophoresis. Sep;23(19):3385-91. (2002).

Targets

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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
Ige receptor activity
Specific Function
Binds to the Fc region of immunoglobulins epsilon. High affinity receptor. Responsible for initiating the allergic response. Binding of allergen to receptor-bound IgE leads to cell activation and t...
Gene Name
FCER1A
Uniprot ID
P12319
Uniprot Name
High affinity immunoglobulin epsilon receptor subunit alpha
Molecular Weight
29595.67 Da
References
  1. Beck LA, Marcotte GV, MacGlashan D, Togias A, Saini S: Omalizumab-induced reductions in mast cell Fce psilon RI expression and function. J Allergy Clin Immunol. 2004 Sep;114(3):527-30. [Article]
  2. Mirkina I, Schweighoffer T, Kricek F: Inhibition of human cord blood-derived mast cell responses by anti-Fc epsilon RI mAb 15/1 versus anti-IgE Omalizumab. Immunol Lett. 2007 Apr 15;109(2):120-8. Epub 2007 Mar 1. [Article]
  3. Godse K, Mehta A, Patil S, Gautam M, Nadkarni N: Omalizumab-A Review. Indian J Dermatol. 2015 Jul-Aug;60(4):381-4. doi: 10.4103/0019-5154.160490. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
Ige receptor activity
Specific Function
High affinity receptor that binds to the Fc region of immunoglobulins epsilon. Aggregation of FCER1 by multivalent antigens is required for the full mast cell response, including the release of pre...
Gene Name
MS4A2
Uniprot ID
Q01362
Uniprot Name
High affinity immunoglobulin epsilon receptor subunit beta
Molecular Weight
26533.365 Da
References
  1. Overington JP, Al-Lazikani B, Hopkins AL: How many drug targets are there? Nat Rev Drug Discov. 2006 Dec;5(12):993-6. [Article]
  2. Imming P, Sinning C, Meyer A: Drugs, their targets and the nature and number of drug targets. Nat Rev Drug Discov. 2006 Oct;5(10):821-34. [Article]
  3. DuBuske LM: IgE, allergic diseases, and omalizumab. Curr Pharm Des. 2006;12(30):3929-44. [Article]
  4. Raunio H, Rautio A, Gullsten H, Pelkonen O: Polymorphisms of CYP2A6 and its practical consequences. Br J Clin Pharmacol. 2001 Oct;52(4):357-63. [Article]

Drug created at June 13, 2005 13:24 / Updated at January 02, 2024 23:41