Abstract Introduction Biological therapies have been proven to reduce exacerbations and corticosteroid dependency in severe asthma. However, in real-world settings, full adherence to treatment is often lacking, and the effectiveness of partial adherence remains uncertain. Methods A population-based retrospective cohort study including all patients who initiated treatment with omalizumab, dupilumab, benralizumab, mepolizumab, or reslizumab at Clalit Health Services between January 1st 2018, and December 31st 2022. Patients were followed for two years. Treatment adherence, the number of acute exacerbations, total annual prednisone dose, and treatment failure were evaluated. Results A total of 1,133 patients were included in the study; 535 demonstrated partial adherence. Biologic therapies significantly reduced the annual prednisone dose (by 59.1-74.4% from baseline) and the exacerbation rate (by 21-43% from baseline) among patients with adequate adherence (P 0.001). Similarly, among partially adherent patients, all biologics reduced annual prednisone use by 41.7-63.8% and exacerbation rates by 30-51.4%. Anti-IL-5/IL-5R agents significantly lowered blood eosinophil counts in both adequately and partially adherent groups. Most adequately adherent patients did not require a medication switch. Although switches were more common among partially adherent patients, the majority still did not experience treatment failure. Notably, medication switches were rare among dupilumab-treated patients, regardless of adherence level. Conclusions Our findings demonstrate that, in real-world clinical practice, as in randomized controlled trials, biologic therapies are effective in reducing exacerbations and corticosteroid use in patients with severe asthma. importantly, comparable benefits were also observed among patients with partial adherence to therapy. Figure 1: efficacy of full adherence (left column, panels A-D) and partial adherence (right column, panels E-H) of biologic therapy in severe asthma: This abstract is funded by: none
Khoury et al. (Fri,) studied this question.