Escalation to Biologics in Asthma: The Role of Suboptimal Treatment Adherence

multiple inhalers on a white background
multiple inhalers on a white background
To what extent are patients with uncontrolled asthma switched to biologics due to poor treatment adherence vs lack of maintenance therapy efficacy?

The following article is a part of conference coverage from the American Academy of Allergy, Asthma & Immunology Annual Meeting, being held in Phoenix, Arizona, from February 25 to 28, 2022. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the AAAAI 2022 Virtual Annual Meeting.

In patients with uncontrolled asthma, the need for escalation to biologics may often be attributable to suboptimal treatment adherence rather than to lack of efficacy of the  maintenance therapy. This was among the findings of research being presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting, held in Phoenix, Arizona, from February 25 to 28.

Although a step-by-step approach to asthma treatment is recommended by the Current Global Initiative for Asthma guidelines, up to 59% of patients prescribed high-dose inhaled corticosteroid/long-acting beta-agonist combination therapy fail to achieve control, according to recent studies. Researchers sought to investigate whether or not suboptimal adherence to the prescribed treatment instead of the lack of efficacy of the maintenance therapy was the reason for poor control.

This retrospective analysis included data from the IQVIA Real World Claims US Database and ambulatory electronic medical records claims between January 2016 and June 2020 for 506 patients (69% female) age 12 years or older with diagnosed asthma who had been escalated to biologics.  All patients had been enrolled for 12 months before being escalated to their first biologic treatment.

The researchers examined adherence to oral corticosteroids (OCS) and other controller medication classes for the 12 months prior to the first escalation, with adherence defined as the ratio of the days the patient was supplied with controller medications to the total 12-month duration (adherence = proportion days covered [PDC]). Suboptimal adherence was defined as PDC less than 80%. The investigators discovered that 63% of the patients had suboptimal adherence (PDC <80%) to controller medication (66% of patients had 1 or more claim for OCS) in the 12 months prior to being escalated to biologics (mean PDC: 59.3%).

“This analysis suggests that many patients with uncontrolled asthma are escalated to biologics despite suboptimal maintenance therapy adherence. For some, adherence may have been insufficient to assess the need for biologics,” the researchers concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


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Bender B, Brown R, Hill T, Casciano J, Dotiwala Z, Mayen-Herrera E. Suboptimal adherence to controller medication is widespread among asthma patients escalated to biologics: an analysis of US Claims Data. Presented at: the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting; February 25-28, 2022; Phoenix, AZ. Abstract 269.