ArticleTherapeutic advances in respiratory disease
Rate and predictors of biologic initiation in patients with severe asthma: a retrospective cohort study.
Article in Therapeutic advances in respiratory disease. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBiologic therapy uptake for poorly controlled severe asthma is suboptimal despite guideline recommendations.
objectivesTo evaluate real-world biologic initiation trends and predictors among patients with severe uncontrolled asthma (SUA) and SUA with eosinophilic phenotype (SUA-EP).
designA retrospective real-world cohort study that used Komodo Health administrative claims to identify US patients with SUA (controller/rescue medication use and ⩾2 asthma exacerbations in a year) and a subgroup of patients with SUA-EP (blood eosinophil count ⩾150 cells/µL in the year pre- or post-exacerbation).
methodsBiologic initiation trends following first asthma exacerbation were assessed, and factors associated with lack of biologic initiation following second exacerbation (SUA-EP only) were identified using LASSO regression models; odds ratios (OR), 95% confidence intervals (CIs), and
resultsBiologic initiation rates following the first exacerbation were low at 12.7% (4360/34,246) and 12.2% (309/2526) of patients with SUA and SUA-EP, respectively; mean time between second exacerbation and initiation was 13.4 and 11.9 months. Predictors of lack of biologic initiation included young age (12-17 years; OR (95% CI) 3.65 (1.69-7.89)), primary care physician specialty at index relative to respiratory specialist (2.89 (2.04-4.10)), and antibiotic use (2.29 (1.44-3.66); all
conclusionDespite eligibility, most patients with SUA and SUA-EP did not receive any biologic; younger age and primary care management were predictors of lack of biologic initiation. This highlights the need for improved specialist referral and biologic uptake.
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