Medication Adherence in Patients With Severe Asthma Prescribed Oral Corticosteroids in the U-BIOPRED Cohort

Alahmadi, Fahad; Simpson, Andrew; Gómez, Cristina; Ericsson, Magnus; Thörngren, John‐Olof; Fleming, Louise; Adcock, Ian M.; Chung, Kian Fan; Dahlén, Sven‐Erik; Ahmed, Hassan; Auffray, Charles; Bakke, Per; Bansal, Aruna T.; Baribaud, Frédéric; Bates, Stewart; Bel, Elisabeth H.; Bigler, Jeanette; Bisgaard, Hans; Boedigheimer, Michael; Bønnelykke, Klaus; Brandsma, Joost; Brinkman, Paul; Bucchioni, E.; Burg, Dominic; Bush, Andy; Caruso, Massimo; Chaiboonchoe, Amphun; Chanez, Pascal; Chung, Fan; Compton, Chris; Corfield, Julie; D’Amico, A.; Dahlén, Barbro; Dahlén, Sven Erik; Meulder, Bertrand De; Djukanović, Ratko; Erpenbeck, Veit J.; Eržen, Damijan; Fichtner, K.; Fitch, Neil; Fleming, Louise; Formaggio, Elena; Fowler, Stephen J.; Frey, Urs; Gahlemann, Martina; Geiser, Thomas; Goss, Victoria; Guo, Yi; Hashimoto, Simone; Haughney, John; Hedlin, Gunilla; Hekking, Pieter-Paul; Higenbottam, Tim; Hohlfeld, J.M.; Holweg, Cécile; Horváth, Ildikó; Howarth, Peter H.; James, Anna; Knowles, Richard G.; Knox, Alan J.; Krug, Norbert; Lefaudeux, Diane; Loza, Matthew; Lutter, René; Manta, Alexander; Masefield, Sarah; Matthews, John G.; Mazein, Alexander; Meiser, Andrea; Middelveld, Roelinde; Miralpeix, Montse; Montuschi, Paolo; Mores, Nadia; Murray, Clare; Musiał, Jacek; Myles, David; Pahus, Laurie; Pandis, Ioannis; Pavlidis, Stelios; Postle, Anthony D.; Powel, P.; Praticò, G.; Valls, M. Puig; Rao, Navin; Riley, John; Roberts, Amanda; Roberts, Graham; Rowe, Anthony; Sandström, Thomas; Schofield, James; Seibold, Wolfgang; Selby, Anna; Shaw, Dominic; Sigmund, Ralf; Singer, Florian; Skipp, Paul; Sousa, Ana R.; Sterk, Peter J.; Sun, Kai; Thornton, Bob; Aalderen, W. M. van; Geest, Marleen van; Vestbo, Jørgen; Vissing, Nadja Hawwa; Wagener, Ariane H.; Wagers, Scott; Weiszhart, Z.; Wheelock, Craig E.; Wilson, Susan J.

doi:10.1016/j.chest.2021.02.023

Cited by 12 publications

(3 citation statements)

References 35 publications

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“… 37 On the contrary, low adherence to OCS was reported in roughly 40% of SA patients in the U-BIOPRED cohort. 38 Of note, treatment adherence was defined by prescription records and clinical impressions, which varied by settings of ISAR cohort. Regardless of subjective or objective measures, the findings that biologic initiators have more uncontrolled asthma and mostly full treatment adherence to ICS was in line with GINA recommendations.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Patients in the International Severe Asthma Registry with High Steroid Exposure Who Did or Did Not Initiate Biologic Therapy

Chen¹,

Sadatsafavi²,

Tran³

et al. 2022

JAA

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Background Many severe asthma patients with high oral corticosteroid exposure (HOCS) often do not initiate biologics despite being eligible. This study aimed to compare the characteristics of severe asthma patients with HOCS who did and did not initiate biologics. Methods Baseline characteristics of patients with HOCS (long-term maintenance OCS therapy for at least 1 year, or ≥4 courses of steroid bursts in a year) from the International Severe Asthma Registry (ISAR; https://isaregistries.org/ ), who initiated or did not initiate biologics (anti-lgE, anti-IL5/5R or anti-IL4R), were described at the time of biologic initiation or registry enrolment. Statistical relationships were tested using Pearson’s chi-squared tests for categorical variables, and t-tests for continuous variables, adjusting for potential errors in multiple comparisons. Results Between January 2015 and February 2021, we identified 1412 adult patients with severe asthma from 19 countries that met our inclusion criteria of HOCS, of whom 996 (70.5%) initiated a biologic and 416 (29.5%) did not. The frequency of biologic initiation varied across geographical regions. Those who initiated a biologic were more likely to have higher blood eosinophil count (483 vs 399 cells/µL, p=0.003), serious infections (49.0% vs 13.3%, p<0.001), nasal polyps (35.2% vs 23.6%, p<0.001), airflow limitation (56.8% vs 51.8%, p=0.013), and uncontrolled asthma (80.8% vs 73.2%, p=0.004) despite greater conventional treatment adherence than those who did not start a biologic. Both groups had similar annual asthma exacerbation rates in the previous 12 months (5.7 vs 5.3, p=0.147). Conclusion Around one third of severe HOCS asthma patients did not receive biologics despite a similar high burden of asthma exacerbations as those who initiated a biologic therapy. Other disease characteristics such as eosinophilic phenotype, serious infectious events, nasal polyps, airflow limitation and lack of asthma control appear to dictate biologic use.

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Section: Discussionmentioning

confidence: 99%

Characterization of Patients in the International Severe Asthma Registry with High Steroid Exposure Who Did or Did Not Initiate Biologic Therapy

Chen¹,

Sadatsafavi²,

Tran³

et al. 2022

JAA

View full text Add to dashboard Cite

show abstract

“…Adherence to treatment recommendations of patients with bronchial asthma remains unsatisfactory. Alahmadi et al [39], in their study analyzing the adherence levels of 166 patients with severe asthma participating in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes) trial, determined adherence to ICS to be suboptimal in 37% of subjects. Bassam et al [40] assessed the adherence of 7203 patients treated for asthma at 577 centers.…”

Section: Medication Adherence In Asthmamentioning

confidence: 99%

Adherence to treatment recommendations of patients with chronic non-communicable respiratory diseases – a narrative review

Henryka¹

2023

J Educ Health Sport

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Despite modern therapeutic solutions, patients with chronic obstructive pulmonary disease (COPD) and asthma do not achieve therapeutic benefits due to emerging obstacles to compliance. This review aimed to present and analyze the results of available studies evaluating the influence of sociodemographic, clinical, and psychosocial factors on the level of adherence of patients with COPD and asthma. This narrative review was based on papers indexed in the following databases: PubMed, MEDLINE, CINAHL, Web of Science, and Scopus. The analyzed studies showed that the adherence level of patients with COPD and asthma is unsatisfactory, ranging from 23.6 to 80%. The main factors increasing the level of adherence of COPD patients mentioned in the analyzed studies were: unemployment, taking LAMA, not smoking cigarettes, belief that medication is necessary, higher education, use of multi-dose DPI and MDI inhalers, a greater sense of self-efficacy, and longer duration of disease. Independent determinants of good adherence of patients with asthma were better quality of life, high level of disease control, treatment with ICS + LABA or FF/UMEC/VI, good knowledge about asthma, and positive attitude towards the disease. According to available studies, determinants lowering adherence among patients with COPD were overweight or obesity, depression, poor quality of life, belief that treatment is harmful, frequent hospitalizations, lack of knowledge about the disease and treatment, sleep disorders, and use of ICS, LABA/ICS. Patients with asthma who received infrequent functional support consumed alcohol and were convinced of the harm and lack of need for treatment were non-adherent. In addition, an association was shown between high levels of adherence and a reduction in ED visits and hospitalizations in asthma and COPD patients.

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“…Specifically, in patients with severe asthma, one such questionnaire, the Medication Adherence Report Scale (MARS), was used in the U-BIOPRED severe asthma cohort to explore alignment with objective measurement of prednisolone in urine. The correlation was poor with adherence detection not matching between methods in 53%, suggesting that self-report using MARS is not effective at identifying poor adherence in this population [ 36 ]. Self-report tools to assess adherence have also been used in COPD [ 37 ], but it seems likely that the same limitations will be relevant in assessing individual patient adherence in routine clinical care using these tools.…”

Section: Measuring and Identifying Non-adherencementioning

confidence: 99%

Measuring adherence to therapy in airways disease

Holmes

Heaney

2021

Breathe

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Non-adherence to medication is one of the most significant issues in all airways disease and can have a major impact on disease control as well as on unscheduled healthcare utilisation. It is vital that clinicians can accurately determine a patient's level of adherence in order to ensure they are gaining the maximal benefit from their therapy and also to avoid any potential for unnecessary increases in therapy. It is essential that measurements of adherence are interpreted alongside biomarkers of mechanistic pathways to identify if improvements in medication adherence can influence disease control.In this review, the most common methods of measuring adherence are discussed. These include patient self-report, prescription record checks, canister weighing, dose counting, monitoring drug levels and electronic monitoring. We describe the uses and benefits of each method as well as potential shortcomings. The practical use of adherence measures with measurable markers of disease control is also discussed.Educational aimsTo understand the various methods available to measure adherence in airways disease.To learn how to apply these adherence measures in conjunction with clinical biomarkers in routine clinical care.

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Medication Adherence in Patients With Severe Asthma Prescribed Oral Corticosteroids in the U-BIOPRED Cohort

Cited by 12 publications

References 35 publications

Characterization of Patients in the International Severe Asthma Registry with High Steroid Exposure Who Did or Did Not Initiate Biologic Therapy

Characterization of Patients in the International Severe Asthma Registry with High Steroid Exposure Who Did or Did Not Initiate Biologic Therapy

Adherence to treatment recommendations of patients with chronic non-communicable respiratory diseases – a narrative review

Measuring adherence to therapy in airways disease

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