Patients With Lower SES or Uncontrolled Disease May Be More Likely to Stop Biologic Therapy

Although 90% of patients with severe asthma choose to continue using a biologic, patients with worse disease control at baseline or with lower socioeconomic status (SES) may be more likely to cease biologic use, according to a poster presented at the American Academy of Allergy, Asthma & Immunology 2021 Annual Meeting.

Patients with a lower socioeconomic status or more severe or treatment-refractory asthma were more likely to stop biologic use than other patients with severe asthma, according to a poster presented at the American Academy of Allergy, Asthma & Immunology 2021 Annual Meeting.

These patients were also more frequently living in urban areas and receiving care from pulmonologists instead of allergists or immunologists.

Severe asthma is estimated to impact between 5% and 10% of individuals with asthma. Patients with severe asthma often need care from a subspecialist and intensive therapy.

Although biologic therapies have been shown to reduce exacerbation risks associated with severe uncontrolled asthma and are increasingly being used, real-world data characterizing their use in subspecialist-treated patients with severe asthma is not well known.

The CHRONICLE clinical trial is an ongoing observational study incorporating real-world data on the patterns of patients aged 18 years or older stopping, switching, and continuing use of biologics in the severe asthma population. Patients had to be receiving a monoclonal antibody therapy, a systemic corticosteroid, or other systemic immunosuppressants for 50% or more during the previous year.

Investigators compared clinical characteristics and outcomes associated with asthma for patients enrolled from February 2018 through February 2020 who switched from 1 biologic to another, stopped biologic therapy, or continued biologic use. Data was collected at the time of study enrollment and was updated every 6 months.

Of the 1884 patients enrolled, 1294 (69%) used at least 1 biologic during the study period. In total, there were 1494 biologics uses recorded for 5 biologics:

  • omalizumab (44%)
  • mepolizumab (24%)
  • benralizumab (21%)
  • dupilumab (8%)
  • reslizumab (3%)

There were 134 switches, 101 stops, and 1222 continuations, with several of the 1294 patients qualifying for more than 1 category of biologic use. More than 90% of patients with severe asthma taking a biologic continued taking a biologic through the last data collection compared to 10% of patients who switched biologics and 8% of patients who stopped.

Patients who stopped biologics were more often diagnosed with severe asthma at a younger age, less likely to have full-time employment, more likely to have Medicaid insurance, and more likely to be living in urban areas than patients who continued using a biologic or switched to another biologic.

These patients were also more often treated by a pulmonologist, more likely to have disability related to their asthma, had more maintenance systemic corticosteroid use, and had a lower quality of life as characterized by lower scores for the St. George Respiratory Questionnaire.

Patients who switched from 1 biologic to another were found to have a higher prevalence of nasal or sinus polyps and sensitivity to nonsteroid medications with anti-inflammatory effects.

Investigators noted that the most common reasons reported for switching from or stopping biologic therapy were worsening asthma, reduced medication effectiveness, and medication ineffectiveness.

The investigators noted that patients who continued biologic use likely had better disease control at study enrollment, suggesting that patients with less asthma control at baseline may not see a benefit with biologic therapy. For these patients, more therapeutic options might need to be explored in the future.

Reference

Soong W, Ambrose CS, Carstens D, Trudo F, Moore WC, Panettieri RA. Which severe asthma patietns are switching, stopping, or continuing biologic treatments? Presented at the American Academy of Allergy, Asthma & Immunology 2021 Annual Meeting, February 26-March 1, 2021; Poster 178.