The purpose of this study is to evaluate the efficacy and safety of Omalizumab produced by CinnaGen compared with Xolair® (Genentech, Inc., USA And Novartis Pharmaceuticals Corp, Switzerland) in subjects with uncontrolled Moderate to Severe Allergic Asthma

All the participants will receive one of the following regimens:

Omalizumab (CinnaGen) or Xolair® (Genentech, Inc., USA And Novartis Pharmaceuticals Corp, Switzerland), as subcutaneous injections, Omalizumab was administered every 2 or 4 weeks to provide a dose of at least 0.016 mg/kg/IgE for a duration of 28 weeks

The primary objective of this study is to assess whether the efficacy of Omalizumab (CinnaGen, Iran) is equivalent to Xolair® (Genentech, Inc., USA and Novartis Pharmaceuticals Corp, Switzerland) as measured by rate of protocol-defined asthma exacerbations during the 28-week treatment period

Inclusion Criteria:

1. Ability to provide written, informed consent and to be compliant with the schedule of protocol assessments

2. Positive skin prick or in vitro reactivity test to ≥ 1 perennial aeroallergen

3. Total serum IgE level of ≥30 to ≤700 IU/ml.

4. Moderate to Severe persistent asthma requiring regular treatment with high dose of inhaled corticosteroid (ICS) (GINA 2019 step 4 treatment).

5. Body weight of ≥30 to ≤150

6. History of one of these 2 items during the past 12 months:

   • At least 2 asthma exacerbations which needed systemic corticosteroids, (≥30 days prior to screening)
   • Severe asthma exacerbation in which peak expiratory flow (PEF) or FEV1 was less than 60% of the patient best result and needed systemic corticosteroids and hospitalization or emergency department visit, (≥30 days prior to screening)

Exclusion Criteria:

1. Smoking history of ≥10 pack-years
2. Chronic use of corticosteroids (use of 20 to 30 mg prednisolone for more than 3 weeks) or other immunosuppressant due to other disease except asthma such as autoimmune or collagen vascular disease and etc.
3. Treatment with omalizumab in the 12 months before screening
4. History of severe allergic or anaphylactic reactions to Omalizumab
5. Active lung disease other than asthma
6. Acute upper respiratory tract infection within 1 month before screening
7. Unable to perform spirometry test and other tests needed in the trial
8. Female subjects who are not willing to practice effective contraception (as defined by the investigator) during the study
9. Nursing mothers, pregnant women, and women who planned to become pregnant while on study
10. Participation in any other investigational study within 6 months prior to randomization
11. Unwillingness or inability to comply with the requirements of the protocol including the presence of any condition (physical, mental, or social) that was likely to affect the subject's ability to comply with the study protocol
12. Persons have an asthma exacerbation requiring intubation in the 12 months before screening
13. Unexpected events that prevent patient entering the study