TY - JOUR
T1 - Asthma Patients Who Stop Asthma Biologics Have a Similar Risk of Asthma Exacerbations as Those Who Continue Asthma Biologics
AU - Jeffery, Molly M.
AU - Inselman, Jonathan W.
AU - Maddux, Jacob T.
AU - Lam, Regina W.
AU - Shah, Nilay D.
AU - Rank, Matthew A.
N1 - Funding Information:
This work was funded by the National Institutes of Health , the National Heart, Lung, and Blood Institute (NIH R21 HL140287 ), and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
Publisher Copyright:
© 2021 American Academy of Allergy, Asthma & Immunology
PY - 2021/7
Y1 - 2021/7
N2 - Background: There is limited information about outcomes associated with stopping asthma biologics. Objective: To compare outcomes in people who stopped or continued asthma biologics. Methods: We identified a cohort of people with asthma who stopped or continued asthma biologics in the Optum Labs Database Warehouse, using a propensity matching method for case and control groups with the variables of age, sex, race, region, insurance, income, specialist access, Charlson comorbidity, specific medical conditions, pre-index exacerbation count, pre-index rescue inhaler pharmacy fills, and pre-index inhaled corticosteroid with or without long-acting β-agonist pharmacy fills. Primary outcome used to assess failure of stopping was an increase of 50% or more in the asthma exacerbation rate in the 6 months after discontinuing the biologic compared with the 6-month period before biologic initiation. Results: Among a cohort of 4960 asthma biologic users, 1249 were observed to stop use after 6 to 12 months of use. We identified a matched cohort of 1247 stoppers and 1247 people who continued biologic use for at least 18 months. In the first 6 months after stopping or sham stopping, 10.2% of stoppers and 9.5% of continuers had an increase of 50% or more in asthma exacerbations. We found a similar adjusted odds of failing among stoppers and continuers (odds ratio = 1.085; 95% confidence interval, 0.833-1.413). Conclusions: An increase in asthma exacerbations is infrequently observed in people who stopped asthma biologics and was observed at similar rates as in matched controls who continued asthma biologics.
AB - Background: There is limited information about outcomes associated with stopping asthma biologics. Objective: To compare outcomes in people who stopped or continued asthma biologics. Methods: We identified a cohort of people with asthma who stopped or continued asthma biologics in the Optum Labs Database Warehouse, using a propensity matching method for case and control groups with the variables of age, sex, race, region, insurance, income, specialist access, Charlson comorbidity, specific medical conditions, pre-index exacerbation count, pre-index rescue inhaler pharmacy fills, and pre-index inhaled corticosteroid with or without long-acting β-agonist pharmacy fills. Primary outcome used to assess failure of stopping was an increase of 50% or more in the asthma exacerbation rate in the 6 months after discontinuing the biologic compared with the 6-month period before biologic initiation. Results: Among a cohort of 4960 asthma biologic users, 1249 were observed to stop use after 6 to 12 months of use. We identified a matched cohort of 1247 stoppers and 1247 people who continued biologic use for at least 18 months. In the first 6 months after stopping or sham stopping, 10.2% of stoppers and 9.5% of continuers had an increase of 50% or more in asthma exacerbations. We found a similar adjusted odds of failing among stoppers and continuers (odds ratio = 1.085; 95% confidence interval, 0.833-1.413). Conclusions: An increase in asthma exacerbations is infrequently observed in people who stopped asthma biologics and was observed at similar rates as in matched controls who continued asthma biologics.
KW - Asthma
KW - Biologics
KW - Monoclonal antibodies
KW - Step-down treatment
UR - http://www.scopus.com/inward/record.url?scp=85102878885&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85102878885&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2021.02.031
DO - 10.1016/j.jaip.2021.02.031
M3 - Article
C2 - 33652135
AN - SCOPUS:85102878885
VL - 9
SP - 2742-2750.e1
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
SN - 2213-2198
IS - 7
ER -