Why Do Some Patients with Severe Asthma Discontinue Biologic Therapies? Interview with: Hahn, PhD, Director
U.S. Value Evidence and Outcomes,
Research Triangle Park, NC What is the background for this study?

Response: Biologic therapies are increasing as a treatment for patients with severe asthma, with multiple therapies approved by the FDA.  There is also an increasing understanding of the factors influencing preference for and adherence to biologic therapies for patients with severe asthma; however, little is known about why patients discontinue biologic therapy. In patients who have access to biologic treatment, understanding the circumstances and asthma characteristics associated with discontinuation of biologic therapy may allow for the identification of barriers to treatment success . The objective of this study of cross-sectional physician and patient survey data was to assess the patient characteristics and the given reasons for treatment discontinuation in a US patient cohort with severe asthma treated with biologic therapy.

A total of 117 physicians and 285 patients completed surveys with 70% of patients continuing biologic therapy (N=200). This study included a number of different FDA approved biologics. From the perspectives of the physicians included in the current study (85 providing a rationale for discontinuation), the majority reported a lack of symptom control, particularly shortness of breath (46%), exacerbations (26%) and other chronic symptoms (29%), as a key reason for discontinuing biologic therapy in severe asthma. Symptom control was also key for patients, with these three symptom categories among their top six reasons for biologic discontinuation. The cost of biologic treatment was also an important factor, cited as the 5th most common reason for discontinuation among physicians and the 3rd among patients. What are the main findings? 

Response: Importantly, although discontinuation of biologics for safety reasons has been reported, side effects were cited as a reason for discontinuation by only 15.3% of physicians and 7.8% of patients. Patients who continued therapy (N=200) versus those who ever discontinued a biologic (N=85) were slightly older (mean age 48 vs 44) and were more frequently women (54% vs 47%). Comorbid conditions were similar with the exception of a higher percentage of allergic rhinitis (70% vs 62%), chronic rhinosinusitis (30% vs 13%) and anxiety/depression (23% vs 14%) among those continuing therapy versus those discontinuing.

Although adherence has been linked with treatment discontinuation in some patient populations, this did not appear to be the case in the current study, as almost 80% of patients who discontinued biologic therapy were reported to be very or completely adherent to their treatment. However, treatment satisfaction was shown to correlate with discontinuation, with 84.2% of patients who continued treatment reporting that they were satisfied or very satisfied with their biologic treatment compared to only 48.3% of those who discontinued. While this finding certainly highlights satisfaction as a key consideration in discontinuing treatment, it also demonstrates that around half of patients who discontinued were satisfied with their treatment. What should readers take away from your report?

 Response: Overall, the findings of this study reinforce the need for clinicians to regularly assess symptom control, particularly shortness of breath and exacerbations, as well as a lack of insurance/coverage changes for patients with severe asthma who are receiving biologic therapy. Additionally, as adherence does not necessarily correlate with treatment satisfaction, regular assessments of patient satisfaction with biologic therapy should  be an integral part of care, even in those who are adherent. Likewise, while side effects were not cited as a reason for discontinuation by a large percentage of physicians and patients, providers should continue to assess whether patients are experiencing side effects an and encourage their patients to discuss them.  Finally, to allow a targeted approach to care, demographic and clinical measures, such as sex, age, and comorbidities are also important considerations when predicting which patients may be most likely to discontinue biologic treatment for severe asthma, What recommendations do you have for future research as a result of this work?

Response: It would be interesting to determine the clinical effects of discontinuing biologic treatment in these patients, particularly as discontinuation of such therapies in patients with severe asthma has been associated with loss of asthma control in some patients.

Any disclosures?  This study was funded by GSK (GSK ID: 209643/HO-19-19596).  Beth Hahn is an employee of GSK.


CHEST abstract:
2020 Conference abstract

Reasons Why Patients With Severe Asthma Discontinue Biologic Treatment

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Last Updated on November 3, 2020 by Marie Benz MD FAAD