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Omalizumab dose (Xolair dosing) is based on IgE levels

Omalizumab dose in Asthma is based on the patients' weight and serum Ig E levels. It is indicated for the treatment of chronic idiopathic urticaria and moderately to severely uncontrolled asthma in adults and children who are 6 years and older. Omalizumab is recommended by the GINA (2018) and NAEPP (2007) in patients with severe persistent asthma who do not respond adequately to a combination of high-dose inhaled corticosteroids and long-acting beta-agonists. It is also indicated in children older than 12 years of age and adults with chronic idiopathic urticaria who remain symptomatic despite anti-histamines.

Xolair dosing (Omalizumab dose) in the treatment of Asthma:

The dosing and frequency of omalizumab administration depend on the pretreatment IgE levels and the weight of the patient. When IgE levels drop with therapy, the dose should not be readjusted. However, if the treatment is interrupted for more than one year, the dose should be calculated based on the serum IgE levels then.

Omalizumab dose in Adults with Asthma:

Pretreatment Serum IgE levels of 30-100 units/mL:

Patients weighing 30-90 kgs:
- 150 mg every 4 weeks
Greater than 90-150 kg:
- 300 mg every 4 weeks

Pretreatment Serum IgE levels of more 100-200 units/mL:

Patients weighing 30-90 kgs:
- 300 mg every 4 weeks
Greater than 90-150 kg:
- 225 mg every 2 weeks

Pretreatment Serum IgE levels of more than 200-300 units/mL:

Patients weighing 30-60 kgs:
- 300 mg every 4 weeks
Greater than 60-90 kgs:
- 225 mg every two weeks
Greater than 90-150 kgs:
- 300 mg every 2 weeks

Pretreatment Serum IgE levels of more than 300-400 units/mL:

Patients weighing 30-70 kgs:
- 225 mg every 2 weeks
Greater than 70-90 kgs:
- 300 mg every 2 weeks
Greater than 90 kgs:
- Do not administer the dose.

Pretreatment Serum IgE levels more than 400-500 units/mL:

Patients weighing 30-70 kgs:
- 300 mg every two weeks
Greater than 70-90 kgs:
- 375 mg every two weeks
More than 90 kgs:
- Do not administer the dose

Pretreatment Serum IgE levels more than 500-600 units/mL:

Patients weighing 30-60 kgs:
- 300 mg every two weeks
Greater than 60-70 kgs:
- 375 mg every two weeks
More than 70 kgs:
- Do not administer the dose

IgE levels greater than 600-700 units/mL:

Patients weighing 30-60 kgs:
- 375 mg every two weeks
Greater than 60 kgs:
- Do not administer the dose

Omalizumab dose (Xolair dosing) in Children:

Pretreatment serum IgE levels of 30-100 units/mL:

20-40 Kgs:
- 75 mg every 4 weeks
40-90 kgs:
- 150 mg every 4 weeks
Greater than 90-150 kg:
- 300 mg every 4 weeks

Pretreatment serum IgE levels of more 100-200 units/mL:

20 - 40 Kgs:
- 150 mg every 4 weeks
40-90 kgs:
- 300 mg every 4 weeks
90-125 kg:
- 225 mg every 2 weeks
125 - 150 Kgs:
- 300 mg every 2 weeks

IgE levels of more than 200-300 units/mL:

20 - 30 Kgs:
- 150 mg every 4 weeks
30-40 kgs:
- 225 mg every 4 weeks
40 - 60 Kgs:
- 300 mg every 4 weeks
60-90 kgs:
- 225 mg every two weeks
90-125 kgs:
- 300 mg every 2 weeks
125 - 150 Kgs:
- 375 mg every 2 weeks

IgE levels of more than 300-400 units/mL:

20 - 30 Kgs:
- 225 mg every 4 weeks
30-40 kgs:
- 300 mg every 4 weeks
40 - 70 Kgs:
- 225 mg every 2 weeks
70-90 kgs:
- 300 mg every 2 weeks
Greater than 90 kgs:
- Do not administer the dose.

IgE levels more than 400-500 units/mL:

20 - 25 kgs:
- 225 mg every 4 weeks
25 - 30 kgs:
- 300 mg every 4 weeks
30-50 kgs:
- 225 mg every 2 weeks
50 - 70 Kgs:
- 300 mg every 2 weeks
70 - 90 kgs:
- 375 mg every two weeks
More than 90 kgs:
- Do not administer the dose

IgE levels more than 500-600 units/mL:

20 - 30 Kgs:
- 300 mg every 4 weeks
30 - 40 Kgs:
- 225 mg every 2 weeks
40 - 60 kgs:
- 300 mg every 2 weeks
60 - 70 kgs:
- 375 mg every two weeks
More than 70 kgs:
- Do not administer the dose

IgE levels greater than 600-700 units/mL:

20 - 25 Kgs:
- 300 mg every 4 weeks
25 - 40 Kgs:
- 225 mg every 2 weeks
40 - 50 Kgs:
- 300 mg every 2 weeks
50 - 60 kgs:
- 375 mg every 2 weeks
Greater than 60 kgs:
- Do not administer the dose

IgE levels greater than 700-900 units/mL:

20 - 30 Kgs:
- 225 mg every 2 weeks
30 - 40 Kgs:
- 300 mg every 2 weeks
40 - 50 Kgs:
- 375 mg every 2 weeks
Greater than 50 kgs:
- Do not administer the dose

IgE levels greater than 900-1100 units/mL:

20 - 25 Kgs:
- 225 mg every 2 weeks
25 - 30 Kgs:
- 300 mg every 2 weeks
30 - 40 Kgs:
- 375 mg every 2 weeks
Greater than 40 kgs:
- Do not administer the dose

IgE levels greater than 1100-1200 units/mL:

20 - 30 Kgs:
- 300 mg every 2 weeks
Greater than 30 kgs:
- Do not administer the dose

IgE levels greater than 1200-1300 units/mL:

20 - 25 Kgs:
- 300 mg every 2 weeks
25 - 30 Kgs:
- 375 mg every 2 weeks
Greater than 30 kgs:
- Do not administer the dose

Omalizumab dose (Xolair dosing) in the treatment of chronic idiopathic urticaria:

150 or 300 mg once every 4 weeks administered subcutaneously.
Omalizumab dose for the treatment of chronic idiopathic urticaria does not depend on the body weight and pretreatment IgE levels.

Table summarizing Xolair dosing: [caption id="attachment_10605" align="aligncenter" width="600"] Source: Omalizumab dose based on IgE levels.[/caption]

How to administer Omalizumab (Xolair)?

Omalizumab is administered subcutaneously only. Patients who require doses higher than 150 mg should inject the dose in two divided doses and inject into two separate sites at least one inch apart. It should not be injected into the skin that is infected, broken, scarred, in a mole, or bruised site. It should be injected under the supervision of a healthcare worker. The patient should be observed for about 2 hours after the first three doses and for half an hour after the subsequent doses. Injection sites are similar to those of Insulin. Preferred sites include the anterior abdominal wall, upper arms, front and middle of the thighs. The prefilled syringe should be warmed at room temperature for 15 - 30 minutes. While warming, it should be protected from direct sunlight. Warming in a microwave or warm water should be avoided. The time to peak serum concentration is seen in 7 - 8 days and response to therapy is usually seen in 12 - 16 weeks.