Biologic Dosing Frequency and Real-World Persistence in Severe Asthma

In "Biologic Dosing Frequency and Real-World Persistence in Severe Asthma," the panel weighs how dosing schedules shape whether patients stay on therapy.

Dr. Wechsler reviews the administration burden across current asthma therapies. Most controllers, including inhaled corticosteroids, long-acting beta agonists, and leukotriene modifiers, must be taken once or twice daily.

He points out that even injectable biologics with longer intervals carry a meaningful burden. He cites dupilumab, an anti-IL-4 receptor therapy, dosed every 2 weeks. Mepolizumab, an anti-IL-5 therapy, is given every 4 weeks. Omalizumab, an anti-IgE therapy, is dosed every 2 to 4 weeks. Tezepelumab, an anti-TSLP therapy, is given every 4 weeks.

Patients struggle with daily inhaler routines for many reasons, and he believes relatively frequent injections pose similar challenges. He frames the choice simply. Given the option, who would not prefer a shot every 3 or 6 months rather than every 2 weeks?

He puts numbers to it: 26 injections a year versus 2. In his view, nearly every patient would choose fewer injections. Dr. Bernstein calls that a no-brainer.

Dr. Mosnaim then addresses whether less frequent dosing changes the likelihood that patients stay on therapy. She confirms that real-world data show a clear pattern. Biologics requiring more frequent dosing have higher rates of discontinuation and more delays between doses.

She shares that some of her patients must give themselves a pep talk before every injection. Some patients are comfortable with self-injection, but others find it genuinely difficult. For these patients, frequency matters a great deal.

She reiterates that real-world evidence links longer dosing intervals with higher persistence. Patients are more likely to keep taking biologics that require fewer administrations.

Dr. Bernstein raises a related concern. A glitch in the authorization process might give patients a reason to disengage from therapy. Dr. Mosnaim agrees. She has seen patients decline to push hard for prior authorization renewal, allowing therapy to lapse altogether.

The next episode, "FDA-Approved Asthma Biologics: Mechanisms of Action and Treatment Selection," features Dr. Chupp walking through the approved biologic classes and how practical features shape the final choice.