43 It was shown in the EXTRA study to potentially be able to predict response to omalizumab, where the reduction in exacerbations in the high serum periostin ≥50ng/mL group was 30% vs 3% in the low serum periostin group, though this did not reach statistical significance. 36 High serum periostin was also found in a trial of anti-IL-13 biologic lebrikizumab to predict greater improvement in forced expiratory volume in 1 second (FEV1). 44 However follow-on Phase III studies LAVOLTA I and LAVOLTA II failed to show consistent improvement in exacerbation rates or FEV1 improvement compared to placebo, and selection of patients with high serum periostin did not consistently identify those who would benefit from treatment with lebrikizumab. 45 The clinical use of serum periostin has so far stalled due to several key limitations.
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