Clinical and economic burden of severe asthma among US patients treated with biologic therapies

Abstract

Background: Patients with severe asthma may remain uncontrolled despite biologic therapy in addition to standard therapy, but this disease burden has not been quantified. Objective: To estimate the clinical and economic burden in a US national sample. Methods: Patients who have severe asthma with indicated biologic treatment (earliest use = index date) were selected from the MarketScan database between January 1, 2013, and June 30, 2018. Inclusion criteria were continuous enrollment for 12 months postindex with a minimum of 2 biologic fills, greater than or equal to 12 years of age, evidence of medium-to high-dose inhaled corticosteroids and long-acting b-agonist combination before the index, and absence of other respiratory diagnoses and malignancies. Disease exacerbations (used to classify asthma control), health care costs, and treatment characteristics were reported during the 12-month postindex period. Results: The sample included 3262 biologic patients; 88% with anti−immunoglobulin E therapy (omalizumab) and 12% non−anti-immunoglobulin E (reslizumab, mepolizumab, benralizumab). The mean age was 49 ( §15) years; 64% were women. Prescriptions included inhaled corticosteroids and long-acting b-agonist (82%), systemic corticosteroids (76%), and leukotriene receptor antagonists (68%). Notably, 63% of patients presented greater than or equal to 1 asthma exacerbation (mean 1.3 per patient/year). Furthermore, 35% of patients were categorized as having controlled asthma, whereas 28% were suboptimally controlled and 29% were uncontrolled.

Economic burden of severe asthma treatment: A real-life study

“…Our results are in line with a comprehensive evaluation carried out in the United States on complementary therapies with biological drugs in which it was reported that 63% of patients (n = 3262) presented at least one asthma exacerbation per year (M = 1.3). 29 Taken together, both studies—ours and that of Reibman et al. 29 suggest that although biological drug therapies have led to substantial improvements in patients’ quality of life, adjustments in accuracy based on the asthma phenotype are still required.…”

“… 29 Taken together, both studies—ours and that of Reibman et al. 29 suggest that although biological drug therapies have led to substantial improvements in patients’ quality of life, adjustments in accuracy based on the asthma phenotype are still required. Our results also showed that at least 38% of the patients need a better assessment of asthma phenotypes and comorbidities.…”

“…The goal is to promote phenotype-specific therapies with higher cost-effectiveness for public health systems. 29 , 36…”

Management of Uncontrolled Asthma: A Framework for Novel and Legacy Biologic Treatments

“… 20 , 21 Unfortunately, approximately 50% of patients with severe asthma are non-eosinophilic and some patients with eosinophilic asthma respond suboptimally to standard therapy and the available biologic therapies or lose control of their asthma after an initial response. 18 , 22 Because of these reasons, discussions with patients on biologic options should occur very early on when first establishing care with asthma specialists. Then, it should continue throughout their lifelong asthma journey, especially if their symptoms are not well uncontrolled.…”

“…2,4 Some continue to be "difficult to control" despite optimal standard therapy and may benefit significantly from the treatment of biologic agents that target IgE, IL-4 receptor, IL-5, IL-5 receptor, and most recently, TSLP. 18,19 Existing biologic therapies have been found to have a greater response among those with eosinophilic asthma (ie, blood eosinophil count of ≥300 cells/mL). 20,21 Unfortunately, approximately 50% of patients with severe asthma are non-eosinophilic and some patients with eosinophilic asthma respond suboptimally to standard therapy and the available biologic therapies or lose control of their asthma after an initial response.…”