Usage of long-acting muscarinic antagonists and biologics as add-on therapy for patients in the United States with moderate-to-severe asthma

Abstract

Objective: Many asthma patients remain uncontrolled on inhaled corticosteroids (ICS) and long-acting beta agonists (LABAs), but guidance for selecting add-on therapies, including long-acting muscarinic antagonists (LAMAs) or biologics, is limited. We describe how prescribing practices for add-on LAMA and biologic therapy have changed with increased treatment options and revised treatment guidelines. We further identify differences in treatment initiation and discontinuation rates by patient characteristics, including concomitant COPD. Methods: This retrospective cohort study analyzed insurance claims in the IBM Marketscan database for adult US asthma patients treated with medium-or high-dose ICS/LABA between 2012 and 2019 (n = 277,373). We used negative binomial regression models to evaluate LAMA and biologic initiation rates and their association with patient characteristics, and survival analysis methods for assessing discontinuation rates. Results: Between 2012 and 2019, LAMA and biologic uptake increased approximately 5-fold and 20-fold, respectively. LAMA initiation was significantly higher among patients with concomitant COPD, a group typically unstudied in clinical trials, versus those with asthma only (rate ratio of 5.90, 95% CI: 5.76-6.04). High-dose ICS/LABA treatment and the need for oral corticosteroid (OCS) bursts had stronger associations with biologic initiation. Probability of discontinuation (i.e. non-persistence) in the first year was 40.5% and 22.7% for those initiating LAMAs and biologics, respectively, with higher LAMA discontinuation rates among patients with asthma only versus those with concomitant COPD. Conclusions: Our results provide insights into how clinicians apply treatment guidelines for initiating add-on LAMA and biologic therapies in moderate-to-severe asthma patients and highlight patients who have an unmet treatment need after discontinuation.

Methods to assess COPD medications adherence in healthcare databases: a systematic review

“…Finally, the impact of early refills was assessed in 46 out of 116 studies (exclusion of initiation studies and implementation methods based on all days supplied as oversupply is automatically included). In general, for patients who refilled Time between end of one prescription and the start of a subsequent one Treatment gap of >X days between the end of one prescription and the start of the subsequent one [16,30,37,41,43,51,58,59,62,63,79,81,109,112,126,128,147,149,151,158,173,176] Treatment gap of >X days between the end of one prescription (prescription end corrected for early refills) and the start of the subsequent one [47,60,80] Treatment gap of >X days between the end of one prescription (prescription end corrected for inpatient stays) and the start of the subsequent one [38,91] Treatment gap of >X days between the end of one prescription (prescription end corrected for early refills and inpatient stays) and the start of the subsequent one [98,119] Treatment gap of >X days (value of X adapted for inpatient stays) between the end of one prescription and the start of the subsequent one [85] Treatment gap of >X days between the end of one prescription and the start of the subsequent one and no re-initiation during the subsequent period [154,155]…”

Better Nurse Practitioner Primary Care Practice Environments Reduce Hospitalization Disparities Among Dually-Enrolled Patients

“…Claims data include patient demographics, diagnosis and procedure codes, hospitalizations and office visits, and the presence of each of the 27 chronic conditions defined by the Chronic Conditions Warehouse 32 . Patients were included if they were 18 or older, were alive at the end of 2015, had at least 1 visit to a provider in one of our practices during the year, and had 2 or more claims for either coronary artery disease (CAD) or diabetes using International Classification of Disease (ICD-9 and ICD-10) codes 33–35 . These conditions were chosen as they are 2 of the most common chronic diseases affecting Medicare-enrolled patients.…”

“…32 Patients were included if they were 18 or older, were alive at the end of 2015, had at least 1 visit to a provider in one of our practices during the year, and had 2 or more claims for either coronary artery disease (CAD) or diabetes using International Classification of Disease (ICD-9 and ICD-10) codes. [33][34][35] These conditions were chosen as they are 2 of the most common chronic diseases affecting Medicare-enrolled patients.…”

Adherence and Persistence to Single-Inhaler Versus Multiple-Inhaler Triple Therapy for Asthma Management

“…1,2 The addition of a LAMA to ICS/LABA maintenance therapy has been shown to improve lung function and symptoms and reduce exacerbation rates in patients with uncontrolled asthma; furthermore, the addition of LAMA is likely to incur substantially lower costs compared with escalating to biologic therapy. [16][17][18][19][20] Until recently, the addition of a LAMA to ICS/LABA therapy (ie, triple therapy) for asthma maintenance was only available in the form of multiple-inhaler triple therapy (MITT), usually with different devices or differing dosing regimens. 2 Real-world observational studies in the United States and Japan reported low adherence to, and persistence with MITT among patients with asthma requiring triple therapy.…”