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. 2021 Mar;159(3):924-932.
doi: 10.1016/j.chest.2020.10.050. Epub 2020 Oct 24.

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

Jacob T Maddux  1 , Jonathan W Inselman  2 , Molly M Jeffery  3 , Regina W Lam  4 , Nilay D Shah  5 , Matthew A Rank  6
Affiliations

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

Jacob T Maddux et al. Chest. 2021 Mar.

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.

Keywords: adherence; asthma; biologic; inhaled corticosteroid.

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Figures

Figure 1
Figure 1
Cohort creation flow. HEDIS = Healthcare Effectiveness Dataset Information Set; OLDW = OptumLabs Data Warehouse.
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References

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