Adherence to Asthma Biologics: Implications for Patient Selection, Step Therapy, and Outcomes

Jacob T. Maddux, Jonathan W. Inselman, Molly M. Jeffery, Regina W. Lam, Nilay D. Shah, Matthew A. Rank

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Little is known about adherence to asthma biologics. Research Question: Is adherence to inhaled corticosteroid (ICS) associated with subsequent asthma biologic adherence? Study Design and Methods: We analyzed individuals with asthma who started asthma biologics in the OptumLab Data Warehouse and used that data until October 2019. We calculated proportion days covered (PDC) for ICS ± long-acting β-agonists in the 6 months before and after asthma biologics were started and asthma biologic PDC for the first 6 months of use. We performed a multivariable analysis to identify factors associated with asthma biologic PDC ≥0.75, ICS PDC ≥0.75 during the 6-month period after asthma biologic were started, and achievement of a ≥50% reduction in asthma exacerbations during the first 6 months of asthma biologic use. Results: We identified 5,319 people who started asthma biologics. The mean PDC for asthma biologics was 0.76 (95% CI, 0.75-0.77) in the first 6 months after starting, higher than the mean PDCs for ICS in the 6 months before (0.44 [95% CI, 0.43-0.45]) and after (0.40 [95% CI, 0.39-0.40]) starting the asthma biologic. PDC ≥0.75 for ICS 6 months before index biologic use is associated with PDC for asthma biologics ≥0.75 (OR, 1.25; 95% CI, 1.10-1.43) and for ICS during the first 6 months of biologic use (OR, 9.93; 95% CI, 8.55-11.53). Neither ICS PDC ≥0.75 (OR, 0.92; 95% CI, 0.74-1.14) nor asthma biologic PDC ≥0.75 (OR, 1.15; 95% CI, 0.97-1.36) is associated with a statistically significant reduction in asthma exacerbations during the first 6 months of asthma biologic use among people with any exacerbation in the 6 months before first use. Interpretation: Adherence to asthma biologic is higher than to ICS and is associated with different factors.

Original languageEnglish (US)
Pages (from-to)924-932
Number of pages9
JournalChest
Volume159
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • adherence
  • asthma
  • biologic
  • inhaled corticosteroid

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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