Consistent adherence to biologic therapies is critical for improving outcomes in asthma

Evidence on real-world adherence to asthma biologic therapies and the relevance to clinical outcomes in asthma is limited.

We sought to evaluate biologic use patterns and the relationships between adherence, clinical, and health care resource utilization (HCRU) outcomes and economic burden in patients with asthma.

This was a retrospective observational study using Optum's de-identified Market Clarity Data (Optum Market Clarity) from 2007 to 2023 in adults in the United States with an asthma diagnosis in the 12 months before the first biologic dose (index date) who had ≥12 months of follow-up. Medication possession ratio (MPR; number of doses taken/dosing intervals) and group-based trajectory modeling (GBTM) identified distinct patient adherence patterns and assessed impact on exacerbations, HCRU, and costs (all-cause/asthma-related).

Overall, 10,088 eligible patients were included in the MPR analysis; 54.7% discontinued treatment, 5.2% were minimally adherent, 20.3% were partially adherent, and 19.8% were adherent. Of these, 9,553 did not switch biologic during follow-up and were included in the GBTM analysis. For patients with 1 or more follow-up doses (n = 8,151), MPRs revealed suboptimal biologic adherence (average range, 40.6%-64.0%). GBTM identified 7 adherence clusters, with distinct adherence trajectories categorized from highest to lowest levels of biologic adherence. Patients with the highest adherence generally demonstrated the best outcomes. In patients in less adherent groups, increases were seen in exacerbations defined by asthma-related hospitalizations, all-cause HCRU, and all-cause health care costs. HCRU and asthma-related costs were generally lower for patients with the highest adherence.

Treatment adherence was consistently associated with better all-cause and asthma-related outcomes, highlighting the importance of biologic adherence in patients with asthma.