<p>Real-world characteristics and disease burden of patients with asthma prior to treatment initiation with mepolizumab or omalizumab: a retrospective cohort database study</p>

Abstract

PurposePatients with severe asthma are eligible for asthma-specific biologics as add-on therapies, such as mepolizumab and omalizumab, when optimized controller therapies are unable to control their symptoms. However, few real-world data are available to describe the characteristics and associated economic burden of patients considered to be candidates for mepolizumab or omalizumab therapy.MethodsThis retrospective cohort study investigated patients with asthma (≥12 years of age) identified at the time of first mepolizumab or omalizumab administration (index date) in the MarketScan™ Commercial Database. Data were collected during the 12-month period before the index date (baseline period) for two mutually exclusive patient groups (patients prescribed mepolizumab and omalizumab, respectively). Baseline demographics, history of exacerbations, healthcare resource utilization (HCRU), and medical costs were investigated.ResultsIn total, 413 and 1,834 patients who had been prescribed mepolizumab or omalizumab, respectively, were identified. During the baseline period, patients prescribed mepolizumab experienced more exacerbations (81.4% vs 57.5%, P<0.001), had higher asthma-related HCRU for outpatient services (all P<0.01), and had higher total asthma-related healthcare costs (US$11,000 vs US$7,400, P<0.001) compared with patients prescribed omalizumab. Allergic rhinitis, atopic dermatitis, and chronic idiopathic urticaria were more common among patients prescribed omalizumab vs mepolizumab. In contrast, sinusitis, nasal polyps, and comorbid COPD were more common among patients prescribed mepolizumab vs omalizumab. Prescriptions of fixed-dose inhaled corticosteroids (ICSs) with long-acting β2-agonists (LABAs) and ICS/LABA/long-acting muscarinic antagonist triple therapy during the baseline period were higher among patients prescribed mepolizumab vs omalizumab (80.4% vs 56.8% and 27.1% vs 14.4%, respectively, both P<0.001).ConclusionIn the 12 months prior to initiation of asthma-specific biologics, patients prescribed mepolizumab had a different prevalence of certain comorbidities, higher disease burden, higher HCRU, and higher healthcare costs compared with patients prescribed omalizumab.

EAACI Biologicals Guidelines—Recommendations for severe asthma

“…Of note, patient selection for biologicals in real life might not be optimal: many omalizumab users have low or very low adherence rates for ICSs and/or ICS‐LABA in the 12 months before omalizumab initiation compared the matched cohort of nonusers 208 . In addition, there might be a selection bias as patients prescribed mepolizumab had a different prevalence of certain co‐morbidities such as CRSwNP, higher disease burden, higher healthcare resource utilization and costs compared with patients prescribed omalizumab 209,210 . There is inequity in access to biologicals, as higher likelihood of use was related to middle age, higher income, commercial insurance and access to a specialist 211 …”

Efficacy and safety of treatment with dupilumab for severe asthma: A systematic review of the EAACI guidelines—Recommendations on the use of biologicals in severe asthma

“…The main goal in the management of patients with severe asthma is achieving disease control and reducing risk of attacks while avoiding harm from controller therapies 1,2 . Despite extensive efforts, there is still a small proportion of patients with severe asthma insufficiently controlled with the current medications, with a significant burden due to high morbidity and costs 3‐8 . Current guidelines support the targeted approach in uncontrolled severe asthma, and several biologicals are approved for use in these patients 1,2 …”

Critical Points on the Use of Biologicals in Allergic Diseases and Asthma

“…Of note patient selection for biologicals in real life might not be optimal: many omalizumab users have low or very low adherence rates for ICSs and/or ICS-LABA in the 12 months before omalizumab initiation compared the matched cohort of nonusers 119. In addition, there might be a selection bias as patients prescribed mepolizumab had a different prevalence of certain comorbidities such as CRSwNP, higher disease burden, higher healthcare resource utilization and costs compared with patients prescribed omalizumab 120. Last but not least, use of biologicals remains uncommon, with prevalence peaking in 2006 at 3 in 1,000 individuals with asthma and there is inequity in access to biologicals, as higher likelihood of use was related with middle age, higher income, commercial insurance, and access to a specialist 121…”