Bender B, Oppenheimer J, George M, Brown R, Patel A, Hill T, Boe A, Herrera EM, Dotiwala Z, Casciano J, Bernstein JA. Assessment of real-world escalation to biologics in US patients with asthma. J Allergy Clin Immunol Pract. 2022 Aug 2:S2213-2198(22)00716-4. doi: 10.1016/j.jaip.2022.07.016.
Highlights box
- What is already known about this topic?
- Biologics are recommended as the final step for the treatment of severe asthma, in patients whose asthma remains uncontrolled following high dose maintenance medication. Adherence to maintenance medication should be considered prior to treatment escalation.
- What does this article add to our knowledge?
- Contrary to guideline recommendations, of the patients that were escalated to asthma biologic therapy in this study, the majority had suboptimal adherence to their maintenance medication and/or demonstrated mild GINA severity.
- How does this study impact current management guidelines?
- Healthcare professionals may be prescribing biologics without full understanding of the patient’s prior level of medication adherence or asthma severity. Patient engagement with and adherence to their maintenance medication should be assessed before escalating therapy.
Abstract
Background
Previous studies indicate that suboptimal medication adherence may contribute to uncontrolled asthma. Global Initiative for Asthma (GINA) guidelines recommend treatment escalation to biologics for patients with uncontrolled asthma despite adherence to high dose maintenance medication and who have eosinophilic/allergic biomarkers or require maintenance oral corticosteroids.
Objective
This study aimed to describe the clinical status of patients with asthma escalated to biologic therapy.
Methods
This retrospective claims database analysis enrolled US patients with asthma who were escalated to biologics between January 2016 and June 2020. Exacerbations, control status, GINA Step, and maintenance medication adherence during the 12 months prior to biologic therapy initiation were analyzed. Asthma control was assessed using both the European Respiratory Society/American Thoracic Society (ERS/ATS) and Stempel criteria. Adherence was defined as the proportion of days covered (PDC) by maintenance medication claims.
Results
Of 1786 patients escalated to biologics, 506 were included for analysis. During the 12 months prior to escalation, 346 patients had confirmed exacerbations. Uncontrolled asthma status was estimated in 55% and 70% of patients (ERS/ATS and Stempel criteria, respectively). GINA Step was inferred for 395 patients: 154 were at Step 2, 11 at Step 3, 104 at Step 4, and 126 at Step 5. Of 403 patients with maintenance medication claims, 63% had suboptimal maintenance medication adherence (PDC <80%).
Conclusion
In this study, most patients initiating biologic therapy had mild-moderate asthma or suboptimal maintenance medication adherence, possibly indicating inappropriate escalation. Incorporating objective medication adherence monitoring into existing guidelines may reduce inappropriate escalation to biologics.