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Understanding Patient Beliefs About Administration of Biologics for Asthma

Allison Inserro
A recent study assessed patients’ preferred route of administering biologic drugs for severe asthma, as well as their related beliefs and preferences. The authors said convenience and efficacy beliefs about pharmaceuticals are important for physicians to understand in order to share decision making with patients.
A recent study assessed patients’ preferred route of administering biologic drugs for severe asthma, as well as their related beliefs and preferences. The authors said convenience and efficacy beliefs about pharmaceuticals are important for physicians to understand in order to share decision making with patients.

In shared decision making, patients are provided with detailed information about treatment and medical options, and their preferences are discussed. Other research has shown that shared decision making helps to foster medication adherence, especially if it elicits patients’ beliefs and attitudes toward medication. In addition, understanding treatment choices when they are equally effective helps patients develop accurate expectations of outcomes.

The survey asked about patient beliefs about subcutaneous (SC) and intravenous (IV) administration. While there are currently 5 biologics cleared by the FDA for uncontrolled moderate to severe asthma in the United States, only 2 of these were available in Italy, the location of the survey, during the time of the study (reslizumab and mepolizumab). The others available in the United States are dupilumab, omalizumab, and benralizumab.

Severe asthma is defined as asthma that requires either oral corticosteroids for more than half of the year or the combination of high-dose inhaled corticosteroids and a long-acting β agonist or other controller medication (leukotriene inhibitor/theophylline) to maintain control. Uncontrolled asthma is defined by frequent exacerbations, serious exacerbations, and/or airflow limitation.

When discussing IV, SC, or intramuscular injections, patient preferences may take on a more prominent role, given different potential advantages or disadvantages considering dose, frequencies and duration of administration, associated pain or discomfort, treatment speed of action, setting for drug delivery, and safety.

Previous studies looking at this issue have focused on inflammatory bowel disease, breast cancer, and rheumatoid and psoriatic arthritis, and they have found that SC administration is generally more preferred because it is associated with home setting for treatment, saved time, overall reduced discomfort, and fewer complications related to poor vein access.

On the other hand, the IV route may be preferred by those who associate a hospital setting with safety and the presence of a physician.

Looking to understand more about how patient preference regarding mode of delivery could play out in care for asthma, researchers in Italy administered a cross-sectional observational survey to patients after an outpatient visit to a pulmonary disease clinic. The survey was anonymous and self-administered.

It included sociodemographic and clinical information together with the 12-Item Short Form Survey (SF-12), Work Productivity Impairment Scale, and the medical resources utilization module of the Health & Work Survey. Patients beliefs and preference toward SC and IV administration were probed by an ad hoc 13-item questionnaire, which asked about how much they thought the 2 routes pertained to 4 factors: (1) procedural safety and medical oversight, (2) efficacy and speed of action, (3) social support, and (4) convenience of administration.

Of the 150 patients who were included in the study and completed the questionnaire, 47.3% were men. Preference for IV and SC administration was 18.7% and 81.3%, respectively.

Compared with patients preferring SC formulation, patients who favored IV were older (P ​= ​.04), were less likely to escalate corticosteroid dose (P ​= ​.03), and had emergency department access (P ​= ​.009) during asthma exacerbations. While patients felt that SC dosing was more convenient than IV administration, this belief did not translate into a higher likelihood of preferring SC administration.

IV formulations were more likely to be associated with quicker and more effective drug action (P ​= ​.0001), procedural safety and medical oversight (P ​= ​.0002), and social support (P ​= ​.007).

Predictors of IV preference were represented by the association of worse asthma control and increased use of emergency services, and by beliefs toward formulation effectiveness/efficiency in reducing symptoms (P ​= ​.04 and P ​<.0001, respectively). The model achieved excellent discrimination of administration route preference (area under the curve ​= ​0.87).

The researchers said their findings suggest that beliefs toward convenience and efficacy of drugs with different administration routes should be formally elicited and discussed during doctor–patient interaction to achieve informed shared decision making.

Reference

Santusa P, Ferrando M, Baiardini I, Radovanovica D, Fattoric A, Braidob F.  Patients beliefs on intravenous and subcutaneous routes of administration of biologics for severe asthma treatment: a cross-sectional observational survey study [published online April 28, 2019]. World Allergy Organ J.  doi: 10.1016/j.waojou.2019.100030.

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