Addressing Patient Hesitancy Toward Biologic Therapy for Severe Asthma

"Addressing Patient Hesitancy Toward Biologic Therapy for Severe Asthma" centers on the conversation that moves a hesitant but eligible patient toward treatment.

Dr. Bernstein asks Dr. Chupp how he approaches patients who hesitate to start a biologic out of fear or uncertainty.

Dr. Chupp acknowledges that hesitancy has been an issue, particularly early on, when biologics were first being developed. He believes the explosion of injectable therapies across many diseases has made patients far more accepting today than 10 or 15 years ago.

Still, hesitancy persists. He describes 2 patients in the past month for whom it was the main reason they had not started a biologic, despite being excellent candidates.

Both patients were comfortable with an ultra-long-acting option. They felt an injection every 6 months was far more manageable than a monthly one. They were also more accepting because the drug would be given in the office by a nurse, rather than self-injected at home.

Dr. Chupp also discusses the downstream effects of living without treatment. Those include the cost of lost work and the health effects of systemic steroids. He says those effects cannot be minimized and are massive over the long term.

He explains why the harm is hard for patients to see. A patient may reason that 5 days of prednisone once a year for a flare seems harmless. But repeated year after year, chronic intermittent steroid use becomes a significant problem, and clinicians must explain that clearly.

He also describes the opportunity for a much different breathing experience. Clinicians can now achieve that with biologics, rather than simply escalating inhaled steroids and bronchodilators. He believes physicians must be passionate with patients about what is possible, which can bring them on board to change their health.

Dr. Bernstein adds his own observation. Once patients are doing well on a biologic, their anxiety and fear of an attack diminish or disappear, and they tell him so. Dr. Chupp agrees.

The next episode in this series, "Payer Coverage and Authorization for Severe Asthma Biologics," turns to the payer side, as Dr. Wechsler, Dr. Mosnaim, and Dr. Chupp describe coverage decisions and step requirements.