Low adherence to inhaled corticosteroids/long-acting β₂-agonists and biologic treatment in severe asthmatics

Abstract

Eligibility criteria for a biologic treatment for severe asthma include poor disease control despite a full medication plan according to Global Initiative for Asthma steps 4-5 [1]. Adherence to inhaled therapy should be verified as part of that prescription requirement [2]. In fact, it has been demonstrated that poor adherence is a major cause of uncontrolled asthma, regardless of its severity [3]. Furthermore, biologics do not exert a disease-modifying effect [4]; in contrast to allergen immunotherapy, which is able to permanently modulate the way the immune system reacts to allergens beyond the immunotherapy treatment course [5], biologic therapy withdrawal usually leads to asthma relapse [4]. Thus, a low adherence rate to inhaled treatment in patients undergoing biologic therapy raises some issues related to sustainability. According to the available evidence, suboptimal adherence is particularly prevalent among patients affected by difficult-to-treat asthma, who are reported to take only ∼50% of their prescribed drugs [6, 7]. However, so far, only a few studies, most of them including small populations, have specifically investigated adherence to inhaled medications in patients receiving monoclonal antibodies as add-on therapy before and during the biologic treatment, and none of them has compared subpopulations undergoing different biologic treatments [8-10]. The present study aimed to investigate the adherence rate to inhaled corticosteroids/long-acting β 2-agonists (ICS/LABA) in patients affected by severe asthma prior to and during treatment with omalizumab or mepolizumab. Cite this article as: Caminati M, Vianello A, Andretta M, et al. Low adherence to inhaled corticosteroids/long-acting β 2-agonists and biologic treatment in severe asthmatics.

The potential role of local pharmacies to assess asthma control: an Italian cross-sectional study

“…Although low treatment adherence was the only determinants of poorly controlled asthma, patients recruited in the present study showed a surprisingly high overall crude rate of treatment adherence (92%). This finding is quite unexpected, when considering the actual data from the Italian Medicine Agency (AIFA), which report an overall poor treatment adherence for asthma [27]. Furthermore, the adherence rate, when objectively evaluated, seems to be independent of the disease severity [28,29], so that the prevalence of patients with moderate and severe persistent asthma in our population cannot be truly considered a potential explanation for our observation.…”

The Potential Role of Local Pharmacies to Assess Asthma Control: an Italian Cross-sectional Study

“…This nding is quite unexpected, when considering the actual data from the Italian Medicine Agency (AIFA), which report an overall poor treatment adherence for asthma [27]. Furthermore the adherence rate, when objectively evaluated, seems to be independent of the disease severity [28,29], so that the prevalence of patients with moderate and severe persistent asthma in our population cannot be truly considered a potential explanation for our observation. More likely it re ects the typical overestimation of patients when interviewed about their compliance with therapy, already reported in the open literature [26].…”

The Potential Role of Local Pharmacies to Assess Asthma Control: an Italian Cross-sectional Study

“…This nding is quite unexpected, when considering the actual data from the Italian Medicine Agency (AIFA), reporting an overall poor treatment adherence [27]. Furthermore, the adherence rate, when objectively evaluated, seems to be independent from the disease severity [28,29], so that the prevalence of patients with moderate to severe persistent asthma in our study population cannot be used to explain the above gure. More likely it may re ect the typical overestimation of patients when interviewed about their compliance with therapy, as already reported in the open literature [26].…”