Factors leading to discontinuation of biologic therapy in patients with severe asthma

Figures & data

Figure 1. Reasons for discontinuation of biologic therapy. *Data for patients who provided a reason for discontinuation of therapy and physicians who reported a reason for their patient discontinuing therapy; ^†lack of control of shortness of breath/exacerbations; ^‡includes all other respiratory symptoms not classifiable. OCS, oral corticosteroid.

Figure 2. Asthma medication use at the time of the survey. ICS inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; LRA, leukotriene receptor antagonist; OCS, oral corticosteroid; SABA, short-acting β₂-agonist; SAMA, short-acting muscarinic antagonist.

Table 1. Patient demographics and baseline characteristics.

Patient characteristics	Continued biologic therapy ( n  = 200)	Discontinued biologic therapy ( n  = 85)
Age, years, mean (SD)	47.6 (15.0)	43.8 (15.5)
Female, n (%)	107 (53.5)	40 (47.1)
Employment status, ^a n (%)
Working full time	123 (61.5)	51 (60.0)
Working part time	20 (10.0)	6 (7.1)
On long-term sick leave	6 (3.0)	0 (0.0)
Homemaker	9 (4.5)	9 (10.6)
Student	9 (4.5)	6 (7.1)
Retired	24 (12.0)	9 (10.6)
Unemployed	9 (4.5)	4 (4.7)
Physician specialty, n (%)
Primary care physician	6 (3.0)	0 (0.0)
Pulmonologist	98 (49.0)	42 (49.4)
Allergist	96 (48.0)	43 (50.6)
Health insurance plan
Commercial	154 (77.0)	63 (74.1)
Exchange plan	9 (4.5)	7 (8.2)
Non-Medicare retired benefit	1 (0.5)	0 (0.0)
Medicaid or state equivalent	12 (6.0)	3 (3.5)
Medicare	21 (10.5)	8 (9.4)
Other	0 (0.0)	1 (1.2)
None	1 (0.5)	1 (1.2)
Smoking status, n (%)
Current smoker	1 (0.5)	1 (1.2)
Ex-smoker	37 (18.5)	12 (14.1)
Unknown	3 (1.5)	0 (0.0)
BMI, mean (SD)	28.2 (5.4)	27.3 (5.8)
CCI score, mean (SD)	0.2 (0.7)	0.1 (0.5)

a n = 10 patients who continued biologic therapy and n = 3 patients who discontinued biologic therapy are on sick leave, retired, or unemployed as a result of their asthma.

BMI, body mass index; CCI, Charlson Comorbidity Index Score; SD, standard deviation.

Table 2. Patient comorbidities.

Selected comorbidities, n (%)	Continued biologic therapy ( n  = 200)	Discontinued biologic therapy ( n  = 85)
Allergic rhinitis	140 (70.0)	53 (62.4)
Chronic rhinosinusitis	60 (30.0)	11 (12.9)
Hypertension	51 (25.5)	22 (25.9)
Anxiety and depression	46 (23.0)	12 (14.1)
Elevated cholesterol/hyperlipidemia	32 (16.0)	10 (11.8)
GERD	30 (15.0)	16 (18.8)
Obesity	27 (13.5)	9 (10.6)
Nasal polyps	27 (13.5)	8 (9.4)
Sleep apnea	16 (8.0)	7 (8.2)
Diabetes (with and without chronic complications)	9 (4.5)	6 (7.1)
CAD	9 (4.5)	2 (2.4)
COPD	4 (2.0)	2 (2.4)
CHF	3 (1.5)	1 (1.2)

CAD, coronary artery disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; GERD, gastroesophageal reflux disease.

Figure 3. Exacerbations in the previous 12 months.

Figure 4. Patient adherence to therapy.

Figure 5. Patient (A) and physician (B)-reported reasons for missing a biologic administration appointment.

Figure 6. Comorbidities (A) increasing and (B) decreasing the likelihood of physician prescribing of biologics. CAD, coronary artery disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; GERD, gastroesophageal reflux disease; MI, myocardial infarction; PAH, pulmonary arterial hypertension.

Data availability statement

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