Factors affecting adherence with treatment advice in a clinical trial of patients with severe asthma

Abstract

BackgroundUnderstanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management.MethodsWe reviewed patient choice to follow HCP advice to adjust asthma treatment in a randomised, controlled, single-blind (study participant), multi-centre, parallel group 48-week clinical study comparing biomarker directed treatment adjustment to standard care in severe asthma.ResultsOf 1572 treatment advisories (301 participants), instructions were followed in 1377 cases (87.6%). Patients were more likely to follow advice to remain on treatment (96.7%) than to either reduce (70.3%) or increase (67.1%) their treatment, with 64% of patients following all treatment advice. Multivariate analysis associated belonging to an ethnic minority group (OR: 3.10; 95% CI: 1.68, 5.73) and prior study medication changes (≥2 OR: 2.77, 95% CI: 1.51, 5.10) with failure to follow treatment advice. In contrast, emergency room attendance in the prior year (OR: 0.54, 95% CI: 0.32, 0.92) was associated with following treatment advice. The largest effect was seen with transition onto or off oral corticosteroids (OR: 29.28; 95% CI: 16.07, 53.36) when compared to those requested to maintain treatment. Centre was also an important determinant regarding the likelihood of patients to follow treatment advice.ConclusionsBelonging to an ethnic minority group and multiple prior treatment adjustments were associated with not following HCP treatment advice. Patients also responded differently to HCP advice across UK specialist centres. These findings have implications for generalisability for models of care in severe asthma and require further focussed studies.

Burden of allergic disease among ethnic minority groups in high‐income countries

“…11 The refractory asthma stratification programme demonstrated that patients from ethnic minority groups were less likely to adhere to treatment advised in the clinical trial and had higher asthma exacerbations than white patients. 12 Current guidelines for the use of biologics in asthma are based on data from translational research and clinical trials conducted mainly in white populations from HICs. Whilst ethnicity is considered to be mainly a social construct, a recent case-control study from the USA involving African American, Mexican and Puerto Rican children highlighted key differences in blood parameters influencing eligibility for biologic therapies.…”

“…Data from the UK severe asthma registry and the optimum patient care research database showed that, as compared to the white population, the ethnic minority population was more atopic, expressed higher type 2 inflammation markers and serum total immunoglobulin E (IgE), had lower lung function and worse asthma control 11 . The refractory asthma stratification programme demonstrated that patients from ethnic minority groups were less likely to adhere to treatment advised in the clinical trial and had higher asthma exacerbations than white patients 12 . Current guidelines for the use of biologics in asthma are based on data from translational research and clinical trials conducted mainly in white populations from HICs.…”

Improving Medication Adherence in Asthma

“…36 Higher adherence would be expected in these centers, yet patient outcomes vary considerably across different sites, indicating that multidisciplinary teams alone do not increase adherence. 37 This information highlights the importance of healthcare services in delivering the best quality healthcare for patients with asthma.…”

Tackling ‘People Remodelling’ in Corticosteroid-dependent Asthma with Type-2 Targeting Biologics and a Formal Corticosteroid Weaning Protocol

“…According to Busby et al, 16 up to 30% of patients did not reduce their OCS doses when advised to do so, even though they voluntarily and knowingly enrolled in an algorithm-driven reduction trial. Strikingly, the adherence levels were largely dependent on the recruiting centre, suggesting that the local culture and the manner in which healthcare professionals present the advice are important factors.…”

“…Strikingly, the adherence levels were largely dependent on the recruiting centre, suggesting that the local culture and the manner in which healthcare professionals present the advice are important factors. 16 This may translate into even lower adherence to advice in a real-world clinical setting.…”