Real-World Adherence to Biologic Therapy for Severe Asthma in Children

Biologic medications improve asthma symptoms, spirometry, and exacerbation rates in patients with severe asthma. However, little is known about adherence to biologic medications in children.

To describe adherence to biologic medications in pediatric asthma and evaluate cofactors and outcomes related to adherence.

A retrospective chart review was performed of patients at a single medical center with severe asthma to calculate adherence during the first year on biologic therapy. The relationship of adherence with method of administration (ie, home nursing, clinic, or independent), medication dosing frequency, and insurance was examined using multiple regression models. The effect of biologic therapy on asthma outcomes was analyzed using generalized linear regression models.

Patients demonstrated 84% adherence to biologic therapies during the first 6 months of therapy (SD, 19, n = 186) and 76% over 12 months (SD, 23, n = 155). Method of administration, insurance type, and dosing frequency impacted adherence. Outcomes improved on biologic therapy such that asthma exacerbations decreased by 0.8 (SD, 1.9) exacerbations per year, forced vital capacity z score improved by 0.26 (SD, 0.7), and FEV₁z score improved by 0.3 (SD, 0.8). Decreased exacerbations rates and increased forced vital capacity and FEV₁ were associated with adherence to therapy over the first 12 months.

Patients with severe asthma demonstrated higher rates of adherence to asthma biologic medications than has been demonstrated for inhaled corticosteroids. Biologic therapies were associated with decreased asthma exacerbations and improved spirometry, and these changes were associated with adherence. Medication administration strategy, insurance type, and dosing frequency impacted adherence.