Abstract Rationale Biologic therapies have revolutionized asthma treatment; however, treatment is often delayed or not used in eligible patients. While individual studies have examined these trends, no study has directly compared patterns across complementary real-world data sources. Here we provide a broad view of biologic access and adherence by integrating two complementary real-world data sources. Methods The Komodo Research Database study (January 2016-June 2024) provided claims data from a large patient population, while the US Optum Market Clarity database study (January 2007-June 2023) provided clinical data from electronic health records (EHR) of patients with asthma in the USA. The index date was the first biologic administration (in both studies) or first severe asthma treatment (biologic-eligible patients in Komodo). Studies were analyzed independently. Key differences in eligibility included age (≥12 years Komodo vs ≥ 18 years Optum) and biologic selection (Komodo included biologic-eligible and biologic-initiated patients; Optum included patients receiving an approved biologic). Adherence definitions differed: Komodo defined adherence as no gap 2 dosing intervals and 50% of expected refills; Optum defined adherence by number of doses and interval days specific to each biologic. In Optum, group-based trajectory models identified distinct adherence patterns. Heatmaps were generated to visualize missed doses (illustrating individual dose-timing patterns). Results In the Komodo study, 43,630 patients were eligible with 1-year post-index data. Of these, only 3521 (8.1%) initiated a biologic. A higher proportion of patients receiving high-dose inhaled corticosteroids (ICS; 8.9% 3038/34,178) initiated a biologic versus medium-dose ICS (5.1% 483/9452). Additionally, initiation rates were higher among those with comorbidities, (e.g., eosinophilic granulomatosis with polyangiitis and nasal polyps) than those with severe asthma only, and for those with a respiratory specialist versus primary care provider. Among all patients initiating a biologic in the Komodo study (n = 16,336), 62.6% remained clinically adherent 12 months following biologic initiation, with 68.4% achieving medication possession ratio MPR ≥0.8, and a mean (standard deviation) MPR of 0.83 (0.18). In the Optum study, among 10,088 analyzed patients, 19.8% were adherent after 12 months. Heatmaps revealed frequent interruptions and restarts, with MPRs ranging from 7.5% to 91.6% across pattern clusters. Conclusions Across two databases of claims and EHR data from the USA, asthma biologic initiation remains low despite multiple biologics available over the last decade. Once initiated, adherence is also low and highly variable. These findings highlight systematic gaps in access and adherence for this patient population, and may identify opportunities for improvement. This abstract is funded by: GSK(223657/214570)
Kwiatek et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: