The availability of asthma biologics may not benefit all patients equally.
We sought to identify patient characteristics associated with asthma biologic prescribing, primary adherence, and effectiveness.
A retrospective, observational cohort study of 9,147 adults with asthma who established care with a Penn Medicine asthma subspecialist was conducted using Electronic Health Record data from 1/1/2016 to 10/18/2021. Multivariable regression models were used to identify factors associated with 1) receipt of a new biologic prescription, 2) primary adherence, defined as receiving a dose in the year after the prescription, and 3) oral corticosteroid bursts in the year after the prescription.
Factors associated with a new prescription, which was received by 335 patients, included being a woman (odds ratio=0.66, p=0.002), current smoking (odds ratio=0.50, p=0.04), having an asthma hospitalization in the prior year (odds ratio=2.91; p<0.001), and having 4+ oral corticosteroid bursts in the prior year (odds ratio=3.01, p<0.001). Reduced primary adherence was associated with Black race (incidence rate ratio=0.85, p<0.001) and Medicaid insurance (incidence rate ratio=0.86, p<0.001), although most in these groups, 77.6% and 74.3%, respectively, still received a dose. Nonadherence was associated with patient-level barriers in 72.2% of cases and health insurance denial in 22.2%. Having more oral corticosteroid bursts after receiving a biologic prescription was associated with Medicaid insurance (odds ratio=2.69, p=0.047) and biologic days covered (odds ratio=0.32 for 300-364 days vs. 14-56 days, p=0.03).
In a large health system, primary adherence to asthma biologics varied by race and insurance type, while nonadherence was primarily explained by patient-level barriers.
Copyright © 2023. Published by Elsevier Inc.
