Most dupilumab use for asthma, CRSwNP categorized as persistent
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Key takeaways:
- 25% of patients experienced a gap of 60 days or more since they last filled their prescription.
- Patients with more comorbidities were more likely to persist in their treatment.
Researchers characterized the use of dupilumab among a cohort of patients with asthma, chronic rhinosinusitis with nasal polyps or both as persistent in a study published in Annals of Allergy, Asthma & Immunology.
Treatment lapses were infrequent and often occurred when patients had fewer allergic or immunologic comorbidities, Kristen B. Corey, MD, clinical fellow, department of medicine, Vanderbilt University Medical Center, and colleagues wrote.
The researchers examined the pharmacy records of 81 adults (median age, 51 years; 60% women; 72% white) with a new prescription for dupilumab (Dupixent; Regeneron, Sanofi) received through the institution’s specialty pharmacy.
Based on the records, 38% of these patients were prescribed dupilumab for their asthma, 35% received the prescription for their CRSwNP, and 27% got dupilumab because they had both.
Also, 71% of these patients had moderate to severe asthma. Each patient had 6 months of prescription data or more. The researchers defined non-persistence as a treatment gap of 60 days or longer between the patient’s last prescription fill or lack of a fill, using fill quantity and days’ supply as a guide.
During the study period, 20 (25%) patients were nonpersistent, and 14 (17%) discontinued treatment. Nonpersistent rates included 19% at 3 months and 22% at 6 months, with a median time to non-persistence of 66 days.
Persistence was more likely among patients who also had aspirin-exacerbated respiratory disease than among those patients who did not (P = .042).
Patients with CRSwNP also were more likely to show persistence than the other patients, regardless of their aspirin sensitivity, the researchers said.
There were no differences in persistence based on age, sex, race, or disease indication or severity, the researchers said, although patients with Medicare coverage were less likely to exhibit persistence than those with commercial insurance.
Similarly, there were no differences in persistence between groups based on baseline spirometry metrics, absolute eosinophil count, IgE level, Asthma Control Test score, number of nonbiologic therapies in use when dupilumab was prescribed, or previous T2 biologic use.
The cohort also included 12 patents (15%) with an allergic or immunologic comorbidity and 69 (85%) with two or more comorbidities. Patients with persistence had a median of three comorbidities, and those with non-persistence had a median of two (P = .023).
Based on these findings, the researchers characterized non-persistence as infrequent, but when it did happen, it occurred early in treatment and often among patients with fewer comorbidities.
By understanding factors associated with persistence, the researchers said, physicians may be able to promote it while minimizing adverse health outcomes and costs associated with non-persistence.
Additional studies, the researchers continued, would be helpful in identifying factors that may predict therapeutic response and in eliminating barriers to persistence.
Perspective
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These results might be clinically relevant. They are also logical.
Nonadherence may affect disease control and its burden on society, such as hospitalizations, visit frequency and need for oral corticosteroid courses. Also, nonadherence may result in false positive or false negative results. More studies on this are needed.
It is important for doctors to follow their patients and check on how well they use all their asthma and cytokine release syndrome medications, including inhaled and intranasal medications, during each visit to improve patient adherence. When patients are not adherent, doctors must find out why and make a new treatment plan if needed.
Generally, adherence to medications such as those prescribed for conditions such as hypertension is about 60% to 70%, which is the same level or even lower than those reported in this study.
However, the number of subjects in this study was low, which is a limitation. More studies would be necessary. Additional studies also should compare persistence in dupilumab treatment with other medications as well as why nonadherence happens.
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