SAN ANTONIO — Patients with asthma at one large academic medical center were not prescribed a biologic therapy very often over a 5-year period, a researcher reported, although patient adherence to a prescription was also problematic.
Just 3.7% of patients received a new biologic prescription within a year of referral to a specialist, according to Patrick Gleeson, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia.
The observational study looked at over 9,000 patients who saw a Penn Medicine-based asthma specialist for the first time from 2016-2021 and had no prior exposure to a biologic, including more than 8,000 with complete demographic data.
A multivariable analysis showed that nasal polyposis was linked with greater prescribing of a biologic (OR 4.87, P<0.001), while female sex (OR 0.66, P=0.002) and current smoking (OR=0.50, P=0.04) were tied to lower prescription rates, he reported in a poster presentation at the American Academy of Allergy, Asthma & Immunology annual meeting.
A total of 36 patients who received a prescription, however, did not start within a year. In 72% of cases, patient-level barriers were the key reason for not starting biologic treatment once prescribed, with loss to follow-up (22%), prohibitive cost of treatment (14%), and hesitancy about starting a biologic due to fear or nervousness (11%) being the most common patient-level barriers.
The analysis is among the first to examine factors associated with asthma patient access and adherence to biologic treatments, Gleeson told MedPage Today.
Another 6% said they felt their asthma was under control as a reason for not starting a biologic, 6% said they were too busy, 3% cited failure to get the herpes zoster vaccine before starting mepolizumab (Nucala), and 3% said they decided against treatment due to pregnancy.
Outside of patient barriers, insurance denial was cited in 22% of cases as the key reason for not starting a biologic and provider decision in 6%.
Gleeson told MedPage Today that insurance denial could not be seen as the only key variable in improving access to biologics among asthma patients. “Insurance denial accounted for about one-in-five cases, so it was certainly not the only driver,” he said.
“I think we need to think more about the patient-level barriers to biologic use, beyond insurance coverage,” he said, though he noted that Medicaid patients prescribed a biologic averaged only about 3 months of coverage during a year of follow-up.
In a multivariable analysis to assess biologic adherence, factors associated with adherence showed that Black race and insurance through Medicaid were both linked to lower likelihood of taking a biologic once it was prescribed.
Anne Maitland, MD, PhD, of Mount Sinai Icahn School of Medicine in New York City, told MedPage Today that lack of access due to coverage denial is a routine barrier to biologic usage in the patients she treats.
She explained that by the time patients are referred to her, they tend to have severe asthma so they could really benefit from biologic therapies.
“I can tell you that many times within the Medicaid program, I have found it really difficult to get biologics authorized, and reauthorization is even more of an issue,” said Maitland, who was not involved in the study. “So I may have a patient who goes on a biologic and is doing really well, and they may have to go off in a few months because we don’t have the authorization to continue.”
There was some good news in the study: Among 202 patients with complete biologic dispensing data who received at least one dose of a biologic, there was less need for a short course of an oral corticosteroid during the 12 months after receiving the biologic prescription.
For their study, the researchers reviewed the electronic health records of 9,147 adult asthma patients at Penn Medicine, and examined the first visit to a specialist clinic within the system. Patient demographic factors were available for 8,026 of the patients, and the team also included indicators of baseline exacerbation risk, oral corticosteroid prescriptions, asthma emergency department visits, and hospitalizations as covariates.
Overall, 219 of the patients who were prescribed a biologic had complete dispensing and demographic data, of which 36 did not receive a single dose within 12 months of their prescription.
Disclosures
Gleeson disclosed support from the NIH and the Pennsylvania Allergy Education Research Fund.
Primary Source
American Academy of Allergy, Asthma & Immunology
Source Reference: Gleeson P, et al “Factors associated with asthma biologic prescribing and adherence among adults in a large multi-hospital health system” AAAAI 2023; Poster 225.