Associations Between Social Determinants of Health and Adherence to Biologic Therapies in Patients with Severe Asthma: Real-World Evidence from a Large US Claims Analysis.

内容摘要

This study describes factors associated with biologic initiation and adherence, and impacts of adherence on exacerbations among US patients with severe asthma. This retrospective cohort study defined two populations, biologic-eligible patients and biologic users, using the Komodo Research Database of healthcare claims (2016-2024). The biologic-eligible cohort was defined as patients with severe asthma who had ≥2 exacerbations within 12 months, after the severe asthma index date. Severe asthma was defined as ≥3 month medium-to-high-dose inhaled corticosteroid use with ≥1 overlapping supply with controller therapy. The severe asthma index date was the first day of overlapping treatment supply. Biologic users were defined as patients with ≥2 dispensings of the same biologic and ≥2 asthma diagnoses in the year prior to biologic initiation. In the biologic-eligible cohort, biologic initiation was evaluated and compared between less- and more-favored social determinants of health (SDOH) areas (based on census-level quartiles). Adherence (assessed based on refills and treatment gaps) and exacerbations were assessed among biologic users in the 12 months following biologic initiation and compared between less- and more-favored SDOH areas. Overall 29,652 patients had ≥2 years of follow-up in the biologic-eligible cohort. Of these, 11.3% (n=3362) initiated biologics. In total, 16,336 patients were included in the biologic-user cohort, among whom 62.6% were adherent, 12.1% partially adherent, 3.1% minimally adherent, and 22.3% discontinued treatment. Biologic initiation and adherence were lower in less- versus more-favored SDOH areas. Compared with adherent patients, those who were partially/minimally adherent or discontinued treatment in the 12 months following biologic initiation had significantly more exacerbations post-landmark period (+18% overall and +28% hospitalization-defined exacerbations). Disparities in biologic initiation and adherence exist between severe asthma populations with different characteristics and SDOH. Biologic adherence is associated with fewer exacerbations compared with partial adherence, minimal adherence, and treatment discontinuation. Patients with severe asthma often experience flare-ups (exacerbations) and symptoms that cannot be controlled with treatments such as inhaled steroids and bronchodilators. Injectable biologic medicines that target the type of inflammation experienced by certain patients with asthma are now available. Biologics can reduce asthma flare-ups and improve safety compared with long-term oral steroids, if taken regularly. Relatively few patients start (ie, initiate) biologic treatment. Of those patients who do, the number who keep taking their biologic regularly (ie, adhere to treatment) is low. Lack of biologic initiation and poor adherence can increase the risk of exacerbations for patients with severe asthma. Social determinants of health (SDOH; eg, education, race/ethnicity) can impact initiation and adherence. Using data from the Komodo Research Database (2016–2024), this study assessed factors associated with biologic initiation and adherence and the impact of adherence on exacerbations among US patients with severe asthma. Among patients with 2 years of follow-up who were eligible for biologic therapy, only 11% initiated biologics. Biologic initiation and adherence were lower in less- versus more-favored areas, according to factors such as lack of high school diploma and racial or ethnic or minority status. Per year, patients who were not/less adherent to biologic therapy experienced 18% more exacerbations overall versus adherent patients. These results highlight the need to consider the impact of SDOH factors when developing strategies to support patients initiating biologics so that they can have optimal adherence and hence better asthma outcomes.