Investigating biologic therapy initiation on asthma medication use
Research type
Research Study
Full title
Investigating the association between biologic use, medication adherence and comorbidities in severe asthma: an analysis of linked data
IRAS ID
290836
Contact name
John Busby
Contact email
Sponsor organisation
Queen's University Belfast
Duration of Study in the UK
1 years, 2 months, 30 days
Research summary
Summary of Research
Asthma is common condition affecting around 182,000 patients in Northern Ireland. Around 5% of these are severe asthmatics who remain uncontrolled despite taking high-dose inhaled corticosteroids. These patients suffer a substantial morbidity burden, including frequent exacerbations, and are managed within the Belfast City Hospital Difficult Asthma Service. Recently, several new biologic therapies have been licensed for use in severe asthma. These have been shown to be highly effective in clinical trials, however some patients do not respond to treatment despite having susceptible biology. Identifying and, if possible, addressing the reasons for non-response is crucial to ensure that these high-cost medications are efficiently utilised.Non-adherence to maintenance treatment is a common problem within asthma. Several factors have been associated with non-adherence including beliefs around the necessity of taking treatment. Given the profound effect of biologic medications on asthma symptoms, there is some concern that patients may consider their maintenance treatment to be less necessary, and therefore reduce adherence following biologic initiation with downstream effects on treatment response. Furthermore, little is known about the comorbidity profile of patients receiving biologic treatment within the UK as the RCTs which informed clinical practice generally excluded patients with other diseases. Consequently, the effect of comorbidities on treatment response remains unclear.
The primary aim of this study is to investigate the effect of biologic initiation on maintenance asthma medication adherence. Its secondary aims are to characterise patients receiving biologics, and explore the impact of non-adherence and comorbidities on biologic response through linkage to primary care data.
Summary of Results
Project 1: Investigating the association between biologic use, medication adherence, and comorbidities in severe asthma: an analysis of linked data This study examines how starting biologic treatments affects adherence to inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) therapy in patients with severe asthma. Poor adherence to ICS/LABA is common and linked to worse health outcomes, but it is unclear whether biologics improve adherence or impact clinical results over time. We analysed data from 207 adults at a severe asthma clinic in Northern Ireland between 2015 and 2021. We tracked medication adherence using prescription records and defined good adherence as taking at least 75% of prescribed medication. We then compared adherence before and after starting biologics and explored how adherence influenced asthma symptoms, lung function, and exacerbation rates. Before biologic therapy, 28% of patients had poor adherence, which was more common in patients living in areas of low socio-economic status and linked to higher FeNO levels (a marker of inflammation). While overall adherence rates remained stable after starting biologics, individual patient adherence varied. One year after starting biologics, 33% still had poor adherence. Over time, good adherence was associated with a 17.4% reduction in asthma exacerbations but did not significantly affect lung function or symptoms. The findings suggest that biologics alone do not improve adherence to ICS/LABA, but good adherence is still crucial for reducing exacerbations. Regular counselling and interventions may help improve medication use among patients receiving biologics for severe asthma.https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fpubmed.ncbi.nlm.nih.gov%252F40615077%252F%2FNBTI%2FXnzDAQ%2FAQ%2F0149fd4c-a673-44ae-9b04-147db474d815%2F1%2FJkO6g2iwdh&data=05%7C02%7Capprovals%40hra.nhs.uk%7C1734315ed0da4eba445408de6efd8933%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639070232440825297%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=klvRJcragFn8Cdnwzv3tv2XMPJBO%2FpcJcm6VxzZisvU%3D&reserved=0
Project 2: Greenhouse gas emissions associated with severe asthma care in the United Kingdom
Healthcare is one of the largest sources of greenhouse gas (GHG) emissions in the public sector, with a carbon footprint equivalent to 4.4% of global net GHG emissions. All medicines and healthcare interactions carry a carbon footprint and asthma inhalers are a substantial contributor within the NHS. Data from patients with mild-to-moderate asthma in the UK has shown that the GHG emissions of a patient with poorly-controlled asthma is up to eight times higher when compared to a patient whose asthma is well-controlled, however GHGs have yet to be assessed in patients with severe asthma. Recently, several new biologic medications have become available for the treatment of asthma which reduce symptoms, flare-ups, and hospitalisations. It is accepted that these medications will also reduce GHGs through lower rates of medication use and healthcare contacts, however the scale of this reduction has yet to be estimated. A finding of substantial reductions could suggest that prescribing these expensive medications earlier in the patient pathway could have an important environmental impact in addition to their known healthcare benefits. To address this important evidence gap we compared the GHGs in a group of patients who were eligible for biologics but did not receive them, to a group of patients who are currently being treated in the Belfast City Severe Asthma clinic and did receive biologic medications. The primary aim of this study was to investigate the carbon footprint of patients with severe asthma. Its secondary aim was to estimate the benefits of biologic therapy on GHGs. We found that severe asthma was associated with substantial GHG emissions, primarily driven by short-acting β2-agonist (SABA) use and emergency care utilisation. Although GHG emissions were lower post-biologic, due to a reduction in emergency care, the changes in GHG emissions were modest and SABA use was relatively unchanged. An improved understanding of the factors driving elevated GHG emissions is required.
REC name
HSC REC A
REC reference
21/NI/0038
Date of REC Opinion
9 Feb 2021
REC opinion
Favourable Opinion