Respiratory
THE BIOLOGIC LANDSCAPE: PROGRESS AND REAL-WORLD GAPS
The potential of biologic therapies
Type 2 inflammation is the underlying pathology for more than 80% of patients with severe asthma.1-5
Biologics targeting inflammatory pathways (IgE, IL-5, IL-4/IL-13, TSLP)6 have revolutionized severe asthma treatment.7-9
Proven to reduce exacerbations and OCS use in clinical trials and real-world studies.10-14
Barriers to initiating biologic therapy for asthma can arise from multiple factors, including patient concerns (e.g., fear of injections or treatment frequency), healthcare provider practices (e.g., differences in perceived severity or stepwise focus), and system challenges (e.g., limited infrastructure or delayed referrals).
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REAL-WORLD ADHERENCE
Analysis of 9,553 patients in a cross-sectional cohort study, examining adherence to asthma biologics using machine learning.41
Only ~1 in 5 patients remain highly adherent.41
Beyond the Clinic:
Are We Underestimating
Asthma Biologic Adherence?
Patients who initiate biologics for asthma have varying degrees of adherence, ranging from highly adherent (approximately 21%) to intermittent or discontinued (approximately 79%) within the first year after initiation.
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RISK FACTORS THAT INFLUENCE BIOLOGIC INITIATION AND ADHERENCE IN SEVERE ASTHMA
Click (+) to identify patients at risk and learn about risk factors.
SDOH impact the likelihood of biologic initiation and adherence in the treatment of asthma.
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THE CLINICAL CONSEQUENCES OF LOW ADHERENCE AND PERSISTENCE
Real-world analysis of 16,336 (patients ≥12 years of age at biologic initiation) in a cohort study showed that:14
Non-persistence negatively impacts clinical outcomes.14
US pharmacy and medical insurance claims from the Komodo Research Database investigating persistence to biologic therapy over 12 months and its impact on outcomes in 16,336 patients with ≥2 dispenses of the same biologic agent.14
Weighted RR (95% CI) for not persistent/less persistent* vs. persistent cohort (no treatment gaps of ≥2 doses and >50% refills).14
CONCLUSION / KEY LEARNINGS
Initiate biologic therapy early
Earlier initiation of biologic therapy may reduce the impact of chronic inflammation and improve patient outcomes.25,29,44-47
Identify at-risk individuals
Certain demographic characteristics and SDOH are associated with initiation and poor adherence to biologic therapy.43
Consider therapy characteristics
Low persistence is associated with poor outcomes
Low persistence increases the risk of exacerbations and OCS use.14
Patients are more likely to stay on biologics with less frequent dosing intervals.14
Abbreviations
The publication of this infographic was funded by GSK. This information is scientific and non-promotional in nature and is not intended for further distribution.
Real-world gaps
The potential of biologic therapies
Real-world gaps
Despite the efficacy of biologics, inadequate suppression of underlying inflammation may hinder the ability to achieve asthma treatment goals.6,15-17
Retrospective study using Optum Clinformatics Data (N=2,827) showed that biologic therapies are underutilized, with only 20% of potentially biologic-eligible patients with Type 2 severe asthma receiving biologic treatment.30
Real-world impact of biologics on clinical outcomes depends on adherence and persistence.14
Several barriers to biologic initiation and adherence have been identified.31-40
Patients
HCPs
Lifestyle modification to manage symptoms or exacerbations.31-33
Burden due to treatment frequency or mode of administration.34,35
Difficulties with injection35
Difficulties fitting into schedule/routine, organizing prescription, remembering to receive treatment, and getting to the clinic.35
Fear of injections and concerns around long-term use.35
Patient vs. HCP disease severity disconnect.31,32
Stepwise treatment approach focused on short-term, symptom-based control.30,36,37
Lack of infrastructure supporting biologic use.37,38
Delayed specialist referral.39,40
UNDERSTANDING THE PATHOGENESIS OF TYPE 2 INFLAMMATION IN ASTHMA
Inconsistent control of Type 2 inflammation in asthma drives recurrent exacerbations and disease progression.16-24
Biologic initiation is often delayed until cumulative tissue damage and airway remodeling has occurred.7,24,25
Frequent exacerbations accelerate decline and remodeling as each additional exacerbation was associated with an extra −1.34 L/min decline in peak expiratory flow per year.26
Early initiation and adherence to biologics reduces exacerbations and may improve long-term outcomes.7,25,29
For each decade of asthma duration, the likelihood of achieving well-controlled asthma and meaningful clinical outcomes reduces by 15%, highlighting the importance of early, proactive management.25,26
21.2%
21.9– 41.1%
<15%
78.8%
Age43
Younger patients (18–29 [n=1,485]) vs. ≥70 [n=1,256]) at higher odds of poor adherence (OR 2.02; 95% CI: 1.65–2.47; p<0.001) Patients <60 years have significantly higher odds of poor adherence vs. ≥70 years (all age groups p<0.05).
US pharmacy and medical insurance claims study (2016–2024) evaluating biologic initiation and adherence among biologic‑eligible patients (n=25,139 commercial; 10,527 Medicaid; 7,953 Medicare) and biologic‑initiated patients (n=11,132 commercial; 2,584 Medicare; 2,618 Medicaid), each with 12‑month baseline and follow‑up periods and ≥2 asthma diagnoses and exacerbations.
of patients show intermittent use, treatment gaps, or early/late stop patterns.
average medical possession ratio across all biologics.
of patients maintain high adherence over 12 months.
of patients were consistently adherent for each dosing interval over the 12-month period across biologics.
A MACHINE LEARNING ANALYSES IDENTIFIED SEVEN DISTINCT ADHERENCE CLUSTERS AMONG 9,553 PATIENTS WITHOUT BIOLOGIC SWITCHING41
What is MPR and why does it matter?
MPR is the ratio of days with medication possessed to total days during a 12-month period.
MPR ≥80% is typically considered ʹadherent′.
Impact on inflammation control and outcomes.
Definition41,42
Clinical Meaning42
Social Determinants of Health43
Housing crowding: 5% reduction in initiation in less- (7.9% [1014/12,818]) vs. more-favored (8.3% [706/8477]) areas.
Lack of high school diploma among adults ≥25 years: 26% reduction in initiation in less- (6.7% [662/9808]) vs. more-favored (9.1% [936/10,298]) areas.
Persons of racial, ethnic, or minority status: 12% reduction in initiation in less- (7.6% [1067/14,053]) vs. more-favored (8.6% [454/5302]) areas.
Levels of biologic initiation tend to be higher in the Eastern US, with gaps in data more concentrated in the West.43
Adapted from Maselli et al. 202543
US pharmacy and medical insurance claims study (2016–2024) evaluating biologic initiation and adherence among biologic‑eligible patients (n=25,139 commercial; 10,527 Medicaid; 7,953 Medicare) and biologic‑initiated patients (n=11,132 commercial; 2,584 Medicare; 2,618 Medicaid), each with 12‑month baseline and follow‑up periods and ≥2 asthma diagnoses and exacerbations.
Race/ethnicity43
Black/African American patients: 1.32x higher odds of poor adherence (vs. White patients).
Hispanic/Latino patients: 1.22x higher odds of poor adherence (vs. White patients).
US pharmacy and medical insurance claims study (2016–2024) evaluating biologic initiation and adherence among biologic‑eligible patients (n=25,139 commercial; 10,527 Medicaid; 7,953 Medicare) and biologic‑initiated patients (n=11,132 commercial; 2,584 Medicare; 2,618 Medicaid), each with 12‑month baseline and follow‑up periods and ≥2 asthma diagnoses and exacerbations.
Administration setting43
At-home administration: 1.27x higher odds of poor adherence vs. office administration.
US pharmacy and medical insurance claims study (2016–2024) evaluating biologic initiation and adherence among biologic‑eligible patients (n=25,139 commercial; 10,527 Medicaid; 7,953 Medicare) and biologic‑initiated patients (n=11,132 commercial; 2,584 Medicare; 2,618 Medicaid), each with 12‑month baseline and follow‑up periods and ≥2 asthma diagnoses and exacerbations.
Insurance type43
Medicaid: 1.16x higher odds of poor adherence (vs. commercial insurance).
Medicare: 1.32x higher odds of poor adherence (vs. commercial insurance).
US pharmacy and medical insurance claims study (2016–2024) evaluating biologic initiation and adherence among biologic‑eligible patients (n=25,139 commercial; 10,527 Medicaid; 7,953 Medicare) and biologic‑initiated patients (n=11,132 commercial; 2,584 Medicare; 2,618 Medicaid), each with 12‑month baseline and follow‑up periods and ≥2 asthma diagnoses and exacerbations.
Therapy characteristics
Persistence with biologic therapy varied by biologic agent14*
Biologic treatments administered with less frequent dosing intervals are associated with
*US pharmacy and medical insurance claims study investigating persistence to biologic therapy over 12 months (N=16,336 patients).14
Earlier initiation of biologic therapy may reduce the impact of chronic inflammation and improve patient outcomes.25,29,44-47
*Includes data from those who were partially non-persistent (either treatment gap of ≥2 doses or ≤50% refills), non-persistent (treatment gap of ≥2 doses and ≤50% refills), and those who discontinued biologic therapy (treatment gap of ≥3 doses without resumption); †p<0.05.
Rate of overall exacerbations and IP-/ER-defined exacerbations PPY were significantly increased in the non-persistent cohorts vs. the persistent cohort.
Target populations in earlier disease stages for treatment initiation.25,29,44-47
Younger age/shorter disease duration
Target populations in earlier disease stages for treatment initiation.25,29,44-47
Greater FEV1
at baseline
Target populations in earlier disease stages for treatment initiation.25,29,44-47
No/lower maintenance OCS dose
References
Abbreviations:
ED: emergency department; FEV1: forced expiratory volume in 1 second: HCP: health care professional; ILC2: innate lymphoid cell type 2; IP: inpatient; MPR: medication possession ratio; OCS: oral corticosteroid; OR: odds ratio; RR: rate ratio; SDOH: social determinants of health; TSLP: thymic stromal lymphopoietin; vs: versus.
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Keywords:
Adherence, asthma, biologics, dosing interval, exacerbations, oral corticosteroids (OCS), persistence, shared decision-making, social determinants of health (SDOH).
KEYWORDS
Age43
Younger patients (18–29 [n=1,485]) vs. ≥70 [n=1,256]) at higher odds of poor adherence (OR 2.02; 95% CI: 1.65–2.47; p<0.001) Patients <60 years have significantly higher odds of poor adherence vs. ≥70 years (all age groups p<0.05).
Administration setting
At-home administration (n=7,451): 1.27x higher odds (95% CI: 1.18–1.35; p<0.001) of poor adherence vs. office administration (n=8,885).
Insurance type
Medicaid (n=2,618): 1.16x higher odds (95% CI: 1.05–1.28; p=0.003) of poor adherence vs. commercial insurance (n=11,132) Medicaid (n=2,584): 1.16x higher odds (95% CI: 1.17–1.49; p<0.001) of poor adherence vs. commercial insurance (n=11,132).
Race/ethnicity
Black/African American patients (n=2,136): 1.32x higher odds (95% CI: 1.19–1.47; p<0.001) of poor adherence vs. White patients (n=8,258) Hispanic/Latino patients (n=1,468): 1.22x higher odds (95% CI: 1.08–1.37; p=0.001) of poor adherence vs. White patients (n=8,258).
US pharmacy and medical insurance claims study (2016–2024) evaluating biologic initiation and adherence among biologic‑eligible patients (n=25,139 commercial; 10,527 Medicaid; 7,953 Medicare) and biologic‑initiated patients (n=11,132 commercial; 2,584 Medicare; 2,618 Medicaid), each with 12‑month baseline and follow‑up periods and ≥2 asthma diagnoses and exacerbations.
PSE-US-4595