Omalizumab in the Era of Precision Biologics: Real-World Treatment Persistence, Switching and Phenotype-Directed Transitions in Severe Asthma -A Malaysian Single-Centre Experience

Abstract

Background: Omalizumab established biologic therapy for severe allergic asthma, yet its contemporary position has evolved with the availability of agents targeting IL-5/IL-5Rα, IL-4Rα/IL-13, and thymic stromal lymphopoietin. Real-world evidence describing biologic use in Southeast Asia, including patterns of omalizumab persistence and phenotype-directed switching, remains limited.

Objective: To describe real-world biologic distribution, omalizumab treatment persistence, and documented treatment transitions in a Malaysian specialist severe-asthma service, and to contextualize the continued role of omalizumab within a phenotype-directed biologic stewardship framework.

Methods: A retrospective analysis of a 47-patient severe-asthma biologic registry at Hospital Raja Perempuan Zainab II (HRPZII), Kota Bharu, Malaysia. Demographics, comorbidities, biologic exposure, Asthma Control Test (ACT) scores, spirometry, fractional exhaled nitric oxide (FeNO), blood eosinophils, and total IgE were reviewed. Treatment transitions and their documented reasons were extracted and categorized. The analysis was descriptive owing to small cohort size, non-random biologic allocation, and incomplete longitudinal outcomes.