Do Patients Continue With Biologics for Asthma in Clinical Practice?

While current international asthma guidelines suggest a trial of asthma biologics for at least 4 months, little is known about persistence of asthma biologic use in clinical practice.

A recent abstract prepared and published for the American Academy of Allergy, Asthma & Immunology 2020 Annual Meeting analyzed a cohort of individuals with asthma who used at least 1 asthma biologic.

The researchers used data from 2003-2018 in the OptumLabs Data Warehouse, which includes individuals with commercial and Medicare insurance. Asthma exacerbations were defined as an asthma diagnosis associated with an emergency department visit or hospitalization, or filling a systemic corticosteroid prescription.

Of the 7977 individuals who used asthma biologics, 4659 (58%) had continuous insurance coverage (and thus complete data) for 12 months after starting.

Of individuals with 12 months of continuous coverage, 3123 (67%) continued the asthma biologic for 6 months or longer. Of the 3123 who continued for 6 months, 640 (20%) had a 50% or more reduction in asthma exacerbations in the first 6 months of use compared to the 6 months before starting.

Of the 2483 individuals who failed to achieve a 50% reduction in asthma exacerbations in the first 6 months of treatment, 1640 (66%) continued the asthma biologic for 12 or more months.

The results demonstrate that many patients continue an asthma biologic for 12 months or more without having a 50% or greater reduction in asthma exacerbations during first 6 months of treatment.

In addition, more than 30% of patients fail to complete a 6-month treatment period with an asthma biologic.

Providers should pay attention to the persistence of use of biologics and the timing of discontinuation in order to optimize use, according to the conclusion.

Biologics for severe asthma include reslizumab, mepolizumab, dupilumab, omalizumab, and benralizumab.

Severe asthma is typically defined as asthma that requires either oral corticosteroids for more than half of the year or the combination of high-dose inhaled corticosteroids and a long-acting β agonist or other controller medication (leukotriene inhibitor/theophylline) to maintain control. Uncontrolled asthma is defined by frequent exacerbations, serious exacerbations, and/or airflow limitation.