Among patients with asthma, lower rates of biologic adherence was associated with in-clinic administration of therapy. Low adherence was also associated with factors related to income, educational level, insurance coverage, and racial/ethnic background in patients who self-administered biologics, while better biologic adherence was associated with access to a specialist. These were among research findings published recently in The Journal of Allergy and Clinical Immunology: In Practice.

Although biologic therapy has gained importance as a more effective and better-tolerated alternative to corticosteroids among patients with moderate-to-severe asthma, not all biologics may be self-administered at home, noted study authors. Furthermore, among patients whose biologics are administered in a clinic setting, some must pre-purchase their drugs at a specialty pharmacy and bring them along to the clinic.

In the current retrospective cohort study, researchers sought to identify biologic treatment adherence in cohorts of patients with moderate-to-severe asthma receiving biologics in 3 categories of administration settings: in clinic, at home, or both in clinic and home (referred to by researchers as “hybrid”). Researchers also examined factors associated with adherence in the 3 setting cohorts, as well as associations between treatment adherence and all-cause ED visits.


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The study analyzed data on 3932 patients in the Optum Clinformatics Data Mart with moderate-to-severe asthma who were biologic naïve and had initiated biologic therapy from January 2016 through April 2020. Treatment adherence was defined as the relation of observed to expected biologic dose administrations within 6 months of therapy initiation. Covariates considered in addition to the treatment setting included demographic variables, socioeconomic status, and asthma-associated comorbidities.

Participants were divided into 3 cohorts based on where their therapy was administered: in-clinic only (outpatient office or infusion center; n=2898; 73.7%), home (self-administration; n=786; 20.0%), or hybrid (combination of in-clinic and self-administration; n=248; 6.3%). In assessing each cohort with respect to numerous demographic and other covariates, the researchers found that the clinic-only cohort, compared with the other 2 cohorts, included a higher proportion of patients who were of younger age, male, White, had point-of-service health plans, had fewer comorbidities, and had a higher level of education and higher household income and net worth. In contrast, patients in both the home and hybrid cohorts were relatively older, with at least 70% of patient on Medicare, had more comorbidities, and paid more out-of-pocket for their medications.

The investigators found biologic adherence was 0.83 for the home and hybrid cohorts vs 0.75 in the clinic setting. The researchers also noted certain patterns with respect to covariates. Notably, better adherence was associated with specialist access. Investigators further noted that “Black race, Hispanic ethnicity, lower education, Medicare only insurance and higher patient out-of-pocket cost were associated with worse biologic adherence in some settings.”

Only in the hybrid setting was there a decrease in the hazard for 1-year all-cause ED visits with adherence.

Researchers concluded that “asthma biologic adherence was generally high for moderate-to-severe asthma patients on biologic therapy, but lowest for patients in the clinic setting.” They added that, “Efforts to improve asthma biologic adherence should consider improving specialist access and targeting patient subgroups with higher risk of sub-optimal adherence.”

Study limitations include inconsistency of data and analysis between administration cohorts, the use of pharmacy claims as an indication of biologic administration for in-home and hybrid patients, significant amounts of missing key data, and a short follow-up period.

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

Reference

Osazuwa-Peters OL, Greiner MA, Oberle A, Oakes M, Thomas SM, Bosworth H. Factors related to biologic adherence and outcomes among moderate-to-severe asthma patients. J Allergy Clin Immunol Pract. Published online May 28, 2022. doi:10.1016/j.jaip.2022.05.022