Adherence to asthma biologic therapy higher than inhaled corticosteroids

In a new study, adherence to asthma biologic therapy was higher than adherence to inhaled corticosteroids among adults with asthma.

Researchers reported that adherence to asthma biologics was weakly associated with prior adherence to inhaled corticosteroids.

“Very little is known about adherence to asthma biologics and how adherence may influence asthma outcomes,” Jacob T. Maddux, MD, from the department of medicine at Mayo Clinic, Phoenix, and colleagues wrote in Chest. “There is reason to suspect that adherence to asthma biologics may be different than for inhaled corticosteroids, because biologics are administered with injections given every 2 to 8 weeks and are often administered under direct supervision in a health care setting as compared with inhaled corticosteroids, which are daily self-administered medications that require attention to inhaled technique.”

Researchers analyzed data from the OptumLabs Data Warehouse to identify 5,319 individuals with asthma (61.4% women) who started asthma biologic therapy from 2012 to October 2019. Researchers calculated proportion days covered for inhaled corticosteroids plus long-acting beta agonists 6 months before and after starting asthma biologics as well as proportion days covered for asthma biologic for the first 6 months of use.

During the 6-month period after starting asthma biologics, researchers identified factors associated with asthma biologic and inhaled corticosteroid proportion days covered of at least 0.75 and assessed achievement of an at least 50% asthma exacerbation reduction during the first 6 months using asthma biologics.

In the cohort, 4,100 used omalizumab (Xolair, Genentech), 763 used mepolizumab (Nucala, GlaxoSmithKline), 251 used dupilumab (Dupixent, Sanofi/Regeneron), 141 used benralizumab (Fasenra, AstraZeneca) and 64 used reslizumab (Cinqair, Teva Respiratory).

The mean proportion days covered was higher during the first 6 months after starting a biologic was 0.76 (95% CI, 0.75-0.77), which was higher compared with mean proportion days covered for inhaled corticosteroids during the 6 months before (0.44; 95% CI, 0.43-0.45) and after (0.4; 95% CI, 0.39-0.4) starting an asthma biologic, according to the results. Proportion days covered of at least 0.75 was achieved in 61% of the cohort.

Researchers observed an association between inhaled corticosteroid proportion days covered of at least 0.75 for inhaled corticosteroids 6 months before index asthma biologic use and asthma biologic proportion days covered of at least 0.75 (OR = 1.25; 95% CI, 1.1-1.43) and inhaled corticosteroid use in the first 6 months of using asthma biologics (OR = 9.93; 95% CI, 8.55-11.53).

There was no association between inhaled corticosteroid proportion days covered of at least 0.75 (OR = 0.92; 95% CI, 0.74-1.14) or asthma biologic proportion days covered of at least 0.75 (OR = 1.15; 95% CI, 0.97-1.36) and the researchers reported a significant reduction in asthma exacerbations in the first 6 months using asthma biologics among those with any exacerbation 6 months before use.

“Although these data suggest that common factors for adherence may exist for inhaled corticosteroids and biologics, our multivariable analysis of factors associated with adherence to each medication class yielded results for insurance type and specialist access that were significant and in opposite directions, which may suggest that adherence to inhaled corticosteroids and biologics are different in important ways,” the researchers wrote.

Maddux and colleagues said next steps might include further research on the use of asthma biologics without inhaled corticosteroids to test the efficacy of biologic monotherapy, strategies to enhance biologic adherence and outcomes related to different levels of biologic adherence.

“Policymakers who determine criteria for asthma biologic use and insurance coverage should consider these data in their decisions,” the researchers wrote. “Researchers who study asthma biologics should account for adherence. Providers and patients who make decisions about asthma biologics should consider strategies to measure and promote adherence to asthma biologics.”