The adequate safety and improved symptom burden observed with self-administration of biologic therapies at home for the management of severe asthma and chronic rhinosinusitis with nasal polyps suggests potential in shifting care away from the more costlier in-patient setting.
Self-administration of biologic therapies at home was associated with adequate safety and improved symptom burden in patients with severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), according to study findings published in Chest.
As 2 common inflammation-mediated diseases, asthma and CRSwNP have both been associated with a high economic burden that increases more when the conditions are comorbid. A prior analysis of costs for outpatient and inpatient services for CRSwNP in Poland indicated that inpatient services accounted for a majority of the total cost for the condition.
For asthma, severe disease affects a minority of patients, but increased severity has been shown to further increase the burden of asthma and is associated with high humanistic and economic costs.
Biologic treatment has resulted in reduced health care resource utilization (hospitalizations and oral corticosteroid prescriptions) for severe asthma. However, research has found that the economic burden of severe uncontrolled asthma remains high despite treatment with biologics.
As a potential alternative to the more costlier in-patient setting, the authors of this study sought to analyze the compliance and clinical response associated with self-administration of biologic therapy at home among a group of patients with severe asthma and CRSwNP.
Ten patients with severe asthma (step 5 of Global Initiative for Asthma Guidelines) and CRwNP receiving biologic therapy in the ambulatory care of the Pneumology Department of Azienda Sanitaria Ligure, La Spezia, Italy, were included in the analysis. Participants were educated on how to self-administer when they received the first biologic injection in the clinic and were then switched to self-administration at home.
“They could communicate to a dedicated nurse any adverse event or question. Asthma Control Test (ACT), Severe Asthma Questionnaire (SAQ), and Sino-Nasal Outcome Test (SNOT-22) were performed at baseline and after 3 months,” said the researchers.
Self-administration at home included the biologic therapies mepolizumab (n = 4), dupilumab (n = 3), omalizumab (n = 2), and benralizumab (n = 1), with all patients performing as scheduled.
At baseline, the mean ACT score was 8.8, SAQ was 177.9, and SNOT-22 score was 34. Improvements were observed for all 3 metrics at a 3-month follow-up, with an ACT score of 23.7, SAQ score of 340.3, and a SNOT-22 score of 6.
“Self-administration of biologics at home is safe; patients had good compliance and an improvement of symptoms,” concluded the study authors. “Our study suggests the importance of dedicated pathways in the management of chronic diseases at home to shift the burden of care to the outpatient setting.”
Fui A, Fini D, Sivori M. Self-administration of biologic therapy in severe asthma and chronic rhinosinusitis with nasal polyps: Compliance and quality of life improvement. Chest. Published online June 20, 2022. doi:10.1016/j.chest.2022.04.121