Adherence to asthma biologics varies by therapy given, tends to be low
Key takeaways:
- Researchers assessed patients receiving omalizumab, dupilumab, mepolizumab, benralizumab, reslizumab or tezepelumab for asthma.
- Adherence was deemed intermittent based on heatmaps.
SAN DIEGO — Across six asthma biologics, adherence differed by the therapy given and was often low or irregular based on three adherence measures, according to a presentation here.
This cross-sectional cohort study was presented at the 2025 American Academy of Allergy, Asthma and Immunology/World Allergy Organization Joint Congress.
“Data on the efficacy and durability of biologic treatments are often based in the context of randomized controlled trials where adherence to the treatment on a set schedule is 100%,” Justin Kwiatek, PharmD, senior director and U.S. medical affairs lead at GSK, told Healio.
“But in the real world, patients often do not stick to such strict dosing schedules, and it is important for clinicians to understand what the real-world dosing looks like for their patients, what affects their patients’ ability to stick to a regular schedule and how lower adherence can affect clinical outcomes,” he continued.
Using 2007 to 2023 data from U.S. Optum Market Clarity, Kwiatek and colleagues evaluated 10,088 adults diagnosed with asthma who received an approved biologic therapy — omalizumab (Xolair; Genentech, Novartis), dupilumab (Dupixent; Sanofi, Regeneron), mepolizumab (Nucala, GSK), benralizumab (Fasenra, AstraZeneca), reslizumab (Cinqair, Teva Pharmaceutical) or tezepelumab (Tezspire; Amgen, AstraZeneca) — to gain an understanding of how adherent patients are to these therapies via three measures: medication possession ratio, heatmaps and group-based trajectory modeling.
“Treating chronic severe asthma is a lifelong commitment for those living with the disease, and biologics are a well-established and important long-term therapeutic option,” Kwiatek told Healio.
“That said, biologic efficacy is dependent on patient adherence, and real-world data, like those we are sharing at AAAAI, are an important tool in evolving our understanding of the clinical implications of suboptimal biologic treatment adherence — and ultimately driving optimal shared decision-making,” he said.
Included patients had at least 12 months follow-up, according to the abstract.
Around half of the study population (n = 5,048) had been administered omalizumab either every 2 weeks or every 4 weeks. The second highest biologic given to patients was dupilumab with 2,096 patients, followed by mepolizumab with 1,545 patients, benralizumab with 1,301 patients, reslizumab with 84 patients and tezepelumab with 14 patients.
Researchers found the first time each patient was administered biologic therapy, and for 20% of the total cohort, this was the only time they received the therapy, whereas 7,931 patients received at least one dose in the follow-up period.
The average medication possession ratio (MPR) for the six biologics was higher among those who had a biologic dose during follow-up vs. only at the first administration (30.1%-50.3% vs. 21.9%-41.1%) in a fixed model, according to the abstract.
“The findings from this study indicate that adherence to asthma biologics is lower than previously established,” Kwiatek told Healio.
Switching to a model that “allowed for the dosing interval to be reset if they fell outside the original start date,” Kwiatek and colleagues again observed low average MPRs in the total cohort for each of the six biologics: omalizumab (43.1%), dupilumab (40.1%), mepolizumab (40.3%), benralizumab (42.5%), reslizumab (52.5%) and tezepelumab (33.5%).
Notably, the poster showed that those with at least one follow-up dose in this model (n = 8,558) had higher average MPRs for each biologic than those of the total cohort: omalizumab (50.4%), dupilumab (47.7%), mepolizumab (51%), benralizumab (53.5%), reslizumab (64%) and tezepelumab (40.6%).
Switching back to the fixed model, adherence was deemed intermittent based on heatmaps, and researchers reported that consistent adherence across biologic types was achieved by a small proportion of patients (less than 15%).
“Traditionally, definitions of ‘adherence’ have varied from study to study,” Kwiatek told Healio. “Where one study may count any number of patients who is still taking an asthma biologic several years after starting it to be ‘adherent,’ another may look at the number of times a prescription has been filled over those years — but, prior to this analysis, none had assessed whether patients were getting their medication at the right time.”
When using the final assessment tool of group-based trajectory modeling, the study examined patients who did not switch biologics (n = 9,553) and found seven distinct adherence clusters.
Cluster A had the highest adherence and included 21.2% of this population (average MPR = 91.6%). Following after this cluster, cluster B had late-stage stoppers (8.1%; average MPR = 63%), cluster C had intermittent adherence (13.8%; average MPR = 59.4%), cluster D had half-way stoppers (8.3%; average MPR = 39.1%), cluster E had fluctuated stoppers (11.4%; average MPR = 23.5%), cluster F had delayed stoppers (12%; average MPR = 19.1%) and cluster G had low adherence (25.3%; average MPR = 7.5%), according to the poster.
According to researchers, characteristics of the adherence patterns observed during this modeling included “consistent, early-drop, initial-only and U-shaped.”
“Building on the data we are sharing at AAAAI, we are conducting ongoing research aimed at deepening understanding of the impact of these real-world adherence patterns on outcomes for patients (eg, increased or decreased exacerbations),” Kwiatek told Healio. “Our hopes are that these future data will improve the shared treatment decision-making between clinicians and patients — and ultimately improve long-term asthma management.”