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Integrating objective monitoring of medication adherence into current guidelines has the potential to decrease unwarranted escalation to biologic treatments in asthma patients.
In a comprehensive assessment of the real-world scenario regarding the escalation of biologic therapy in patients with asthma in the United States, concerning findings have emerged. The study delved into the clinical status of these patients who were moved to biologic therapy and brought to light certain critical aspects of asthma management.
Prior research has suggested that suboptimal medication adherence could be a contributing factor to uncontrolled asthma. The Global Initiative for Asthma (GINA) guidelines put forth recommendations for the escalation of treatment to biologics in patients who continue to experience uncontrolled asthma symptoms, despite adhering to high-dose maintenance medication. This recommendation also applies to those who need maintenance oral corticosteroids or exhibit eosinophilic/allergic biomarkers.
The aim was to provide a comprehensive description of the clinical status of asthma patients who were escalated to biologic therapy in the United States. This study employed a retrospective claims database analysis, which included US people battling asthma who had undergone escalation to biologics. The analysis involved examining exacerbation rates, control status, GINA step categorization, and adherence to maintenance medication during the 12 months leading up to the initiation of biologic therapy.
Utilizing both the Stempel criteria and the European Respiratory Society/American Thoracic Society (ERS/ATS), an examination of asthma control was done. Medication adherence was outlined as the proportion of days covered (PDC) based on maintenance medication claims. Out of the 1786 patients who underwent escalation to biologics, 506 patients were included for in-depth analysis. Notably, during the year prior to the escalation, 346 people illustrated confirmed exacerbations.
Astonishingly, it was discovered that 55% and 70% of people were forecasted to have uncontrolled asthma status according to the ERS/ATS and Stempel criteria, respectively. Further analysis revealed the distribution of people across GINA steps: (a) 154 were at step 2, (b) 11 at step 3, (c) 104 at step 4, and (d) 126 at step 5. Among the 403 patients with maintenance medication claims, a concerning revelation was that 63% exhibited suboptimal maintenance medication adherence (PDC less than 80%).
In contrast to the guidance provided by clinical guidelines, this study unveiled that a significant portion of patients who initiated biologic therapy had mild-to-moderate asthma or suboptimal adherence to maintenance medications. This raises questions about the appropriateness of the escalation to biologics in these cases and suggests that healthcare professionals might be prescribing biologics without a comprehensive understanding of the patient's prior medication adherence history or the severity of their asthma.
To ensure the appropriateness of therapy escalation, it is crucial for healthcare providers to assess patient engagement with and adherence to their maintenance medication before making treatment decisions. The study's findings emphasize the potential benefits of incorporating objective medication adherence monitoring into existing guidelines, aiming to reduce the occurrence of inappropriate biologic therapy escalation for asthma patients.
Journal of Allergy and Clinical Immunology
Escalation of biologics in patients with asthma
Bruce Bender et al.
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