Biologics therapy may lead to greater asthma remission in non-white patients
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Key takeaways:
- Biologic therapies are underutilized in non-white populations.
- By identifying barriers to specific biologic therapy, more patients could achieve disease control.
SAN DIEGO — Asthma remission may occur more often with the use of biologics, but non-white patients receive fewer biologics than white patients, according to an abstract presented at the American Thoracic Society International Conference.
“We know that non-white individuals in the United States have an excess burden of asthma morbidity and mortality, and at the same time are less likely to receive biologic therapy than white patients and are underrepresented in existing data for these advanced therapies,” Sarah Rhoads, MD, pulmonary and critical care fellow at University of Colorado and first author of the study, told Healio.
The study included a retrospective chart review of 2,565 asthma patients from National Jewish Health who received biologic therapy from 2015 to October 2023. The patients were evaluated for biologic prescription and stratified by race and ethnicity. A preliminary analysis was also performed on a representative sample of 136 patients to examine remission achievement.
Among the study sample, 1,768 (68.9%) patients identified as non-Hispanic white, and 1,568 (61.1%) identified as female, which constituted the majority of the sample. There also were 128 (5%) patients identifying as Black/African American, 49 (1.9%) identifying as Asian, and 266 (10.4%) reporting Hispanic ethnicity.
Between all non-white patients, omalizumab (Xolair; Genentech, Novartis) was prescribed the most (40.6% of Black patients; 35.7% of Hispanic patients), followed by dupilumab (Dupixent; Regeneron, Sanofi; 33.6% of Black patients; 33.5% of Hispanic patients) and mepolizumab/benralizumab (Nucala, GSK/Fasenra, AstraZeneca; 22.5% of Black patients; 28.6% of Hispanic patients).
Percentages of biologic use among patients of different backgrounds varied as well, the researchers said. For example, 67.1% of omalizumab prescriptions were for white patients, 5.6% were for Black patients and 10.2% were for Hispanic patients.
Similarly, 72.2% of dupilumab prescriptions were for white patients, 4.2% were for Black patients and 8.9% were for Hispanic patients. For mepolizumab, percentages included 69.8% of patients who were white, 2.2% who were Black and 6% who were Hispanic. Benralizumab percentages included 60.4% for white patients, 2.4% who were Black and 6.6% who were Hispanic.
Asian patients accounted for 2.5% of omalizumab prescriptions, 1.9% of dupilumab prescriptions and 2.5% of both mepolizumab and benralizumab prescriptions.
In the representative sample, 89 patients identified as white and 47 as non-white with a mean range of asthma exacerbations prior to biologic use of 2.91 and 3.1 and mean Asthma Control Test (ACT) scores of 14 and 12, respectively.
After 12 months of biologic therapies, the mean number of asthma exacerbations was 0.43 for white patients and 0.15 for non-white patients. White patients reported a mean change from baseline ACT score of 7, with 14 patients discontinuing oral prednisone and 15 discontinuing the use of a controller inhaler. In comparison, non-white patients reported a mean change from baseline ACT score of 11, with five patients discontinuing oral prednisone and six discontinuing the use of a controller inhaler.
“The significance of improvement among our non-white participants, while acknowledging that our study size is small, was really striking,” Rhoads said. “Not only did non-white patients achieve many of the criteria commonly utilized to assess for remission, but in many cases their improvements exceeded that of white patients.”
The representative sample also showed a change from baseline FeNO score of –15 for white patients and –25 for non-white patients as well as a mean change from baseline blood eosinophils levels of four for white patients and –81 for non-white patients.
“These results highlight that the under-utilization of biologic therapy in non-white individuals is something we should really be looking at critically, both on an individual level but also more broadly,” Rhoads told Healio. “The data suggest that efficacy of biologic therapy is not the problem, so our hope is that these results can perhaps encourage further research into effectiveness and also barriers to care. “
Study authors further emphasized the need to be more inclusive in scientific research, especially when it comes to underrepresented and marginalized populations.
“There are no data to support differential biologic underpinnings in asthma; rather, there are often social/economic/institutional disparities that account for differences,” Michael E. Wechsler, MD, MMSc, professor of medicine and director of the NJH Cohen Family Asthma Institute at National Jewish Health and one of the study’s authors, told Healio.
“Underrepresented minorities have been shown to be particularly vulnerable to the morbidity and mortality associated with asthma,” Wechsler continued. “It is reassuring that when these patients are administered biologic therapies, they appear to have as beneficial a response as others.”