Abstract Rationale Previous studies have examined asthma adherence behaviors and their impact on outcomes, but traditional methods are associated with variation and inconsistencies. While the Komodo and Optum studies have independently characterized adherence and outcomes, no analyses have integrated multiple real-world datasets to compare initiation, adherence and outcomes across complementary data sources. This analysis provides a cross-dataset perspective on adherence patterns and their impact on clinical outcomes, offering insights into patient behavior and strategies to improve long-term asthma control. 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. Index date was the first biologic administration. Studies were analyzed independently. Key differences in eligibility included age (≥12 years Komodo vs ≥ 18 years Optum) and patient selection (biologic-eligible/initiated patients Komodo vs patients receiving an approved biologic Optum). 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. In both studies, asthma exacerbation rates were stratified by adherence levels or pattern clusters. Results In Komodo, exacerbation rates were higher in suboptimally-adherent (rate ratio 95% CI: 1.08 1.01-1.16, p=0.024) and non-adherent (1.37 1.21-1.55, p0.001) patients versus adherent patients. In Optum, patients in the least adherent cluster experienced 43.8% more asthma-related emergency visits than the most adherent cluster. While 62.6% of 16,336 patients receiving a biologic in Komodo were clinically adherent after 12 months, only 19.8% of 10,088 patients in Optum were adherent. In Komodo, MPR ≥0.8 was achieved by 68.4% and PDC ≥0.8 by 55.9% of patients; in Optum, MPR ranged from 7.5%-91.6% across clusters. Trajectory analysis captured drop-offs, interruptions, and restarts, providing insights beyond average adherence and revealing behavioral patterns over time. Conclusions Across complementary US datasets, asthma biologic adherence is consistently associated with improved clinical outcomes. By comparing claims and EHR data, this analysis validates the robustness of adherence-outcome relationships and highlights reproducible behavioral patterns. Conceptualizing biologic use in three steps—starting treatment, staying on treatment, and patterns of use over time—provides a practical framework to understand patient behavior and guide interventions to improve long-term asthma control in real-world populations. This abstract is funded by: GSK(223657/214570).
Kwiatek et al. (Fri,) studied this question.