Infectious Disease

Compliance with biological asthma therapy higher than with inhaled corticosteroids

March 19, 2021

2 min read

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

The researchers reported that adherence to asthma biologics was only weakly linked to prior adherence to inhaled corticosteroids.

Source: Adobe Stock.

“Very little is known about adherence to asthma biologics and how adherence can affect asthma outcomes,” wrote Dr. Jacob T. Maddux of the Mayo Clinic Medical Department in Phoenix and colleagues in Chest. “There is reason to believe that adherence to asthma biologics may be different than inhaled corticosteroids, as biologics are injected every 2 to 8 weeks and are often administered under direct healthcare supervision compared to inhaled corticosteroids, daily self-administered medication for which the inhalation technique must be observed. “

The researchers analyzed data from the OptumLabs data warehouse to identify 5,319 people with asthma (61.4% women) who started biological asthma therapy from 2012 to October 2019. The researchers calculated the proportion of days covered 6 months before and after the start of inhaled corticosteroids plus long-acting beta-agonists for asthma biologics, as well as proportion days covered for asthma biologics in the first 6 months of use.

During the 6 month period after starting asthma biologic treatment, researchers identified factors associated with asthma biological and inhalation days with corticosteroid levels of at least 0.75 and rated asthma exacerbation reduction of at least 50% in the first 6 months using asthma biologics.

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

The average percentage of days covered was higher in the first 6 months after starting a biologic and was 0.76 (95% CI, 0.75-0.77), which was higher than the average percentage of days covered in the 6th month Months previously covered for inhaled corticosteroids (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. In 61% of the cohort, proportions of at least 0.75 days were achieved.

The researchers observed a relationship between days with inhaled corticosteroids of at least 0.75 for inhaled corticosteroids 6 months prior to the use of index asthma biologics and days with asthma biologics of at least 0.75 (OR = 1.25; 95% CI, 1.1-1.43) and inhaled corticosteroid use in the first 6 months after using asthma biologics (OR = 9.93; 95% CI, 8.55-11.53).

There was no association between inhaled days with a corticosteroid fraction of at least 0.75 (OR = 0.92; 95% CI, 0.74-1.14) and days with an asthma-biological fraction 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 in patients with an exacerbation 6 months prior to use.

“Although these data suggest that inhaled corticosteroids and biologics may have common compliance factors, our multivariate analysis of the compliance factors associated with each drug class produced results for insurance type and access of professionals that were significant and in opposite directions What might suggest Inhaled corticosteroid and biologic compliance differs in important ways, ”the researchers wrote.

Maddux and colleagues said next steps could include further research into the use of asthma biologics without inhaled corticosteroids to test the effectiveness of biological monotherapy, strategies to improve biological adherence, and results related to different levels of biological adherence.

“Policy makers setting criteria for asthma biologic use and insurance coverage should use this data in their decisions,” the researchers wrote. “Researchers studying asthma biologics should consider compliance. Providers and patients making asthma biologic decisions should consider strategies to measure and promote asthma biologic adherence. “

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