Monoclonal antibody treatment for severe uncontrolled asthma in Spain: analytical map

Abstract

Background

Monoclonal antibodies (mABs) have become available to treat more efficiently patients with severe uncontrolled asthma (SUA). However, the use of mABs is lower than expected given the prevalence of SUA, with significant disparities in the use of these treatments.

Objective

To evaluate the proportion of patients with SUA treated with mABs in Spain, and to analyze some of the factors that could determine these prescription patterns.

Methods

An analysis was performed on the data provided from the Hospitals National Health System (NHS) 2018 catalogue where Chest Diseases Department and a Hospital Pharmacy were available. Random sampling was performed to determine the sample size, stratifying proportionally by geographic area and hospital level. Characteristics of the participating sites, as well as the prescribing of mABs were collected, which included geographic area, hospital levels, prescribing medical specialities, types of clinics, and mABs prescribed.

Results

Data from 90 hospitals were analyzed (Response rate 64.3%). Level 4 hospitals, the Canary Islands geographical area, and the presence of a high complexity Asthma Healthcare Unit (ACU) were associated with a higher probability that the SUA was treated with mABs.

Conclusion

The map of the prescribing of mABs for SUA in Spain shows a significant variation by geographic area, hospital level, type of clinic, and the accreditation level of the ACUs. At the current time, there appears to be significant under-prescribing of these treatments.

Keywords:

• Severe asthma
• monoclonal antibodies
• Mepolizumab
• Dupilumab: Omalizumab
• Reslizumab
• Benralizumab

Acknowledgements

COLLABORATORS: JOSE MARA HERNÁNDEZ PÉREZ, Hospital General de la Palma-La Palma; BERTA ROMÁN BERNAL, Hospital Dr. Jose Molina Orosa- Lanzarote; FELIPE RODRGUEZ DE CASTRO, Hospital Universitario de Gran Canaria Doctor Negrín- Las Palmas de Gran Canaria; HEMILY KATERINE IZAGUIRRE FLORES, Complejo Hospitalario Universitario de Canarias-Las Palmas de Gran Canaria; IRENE M DE LORENZO GARCA, Complejo Hospitalario Universitario Nuestra Señora de Candelaria- Santa Cruz de Tenerife; MARA CELESTE MARCOS, Hospital de Torrejón de Ardoz- Madrid; SLVIA SÁNCHEZ CUELLAR, Hospital Universitario Infanta Leonor- Madrid; TERESA RAMREZ PRIETO, Hospital Universitario Infanta Sofía-Madrid; RODRIGO BRAVO FERNÁNDEZ, Hospital Virgen de la Luz-Cuenca; JOSÉ LUS IZQUIERDO ALONSO, Hospital Universitario de Guadalajara-Guadalajara; CAROLINA CISNEROS, Hospital Universitario La Princesa de Madrid-Madrid; ANTOLN LÓPEZ VIÑA, Hospital Universitario Puerta del Hierro-Majadahonda (Madrid); JESUS JIMENEZ LOPEZ, Complejo Hospitalario Universitario de Albacete- Albacete; FRANCISCO JAVIER CALLEJAS GONZÁLEZ, Complejo Hospitalario Universitario de Albacete- Albacete; CARLOS ALMONACID SÁNCHEZ, Hospital Universitario Ramón y Cajal- Madrid; PERLA VALENZUELA, Complejo Hospitalario de Toledo-Toledo; DAVID ROMERO RIBATE, Complejo Universitario La Paz-Madrid; FRANCISCO JOSÉ CABALLERO SEGURA, Hospital General Universitario Gregorio Marañón- Madrid; MARA MERCEDES PALAU BENAVENT, Hospital de Viladecans-Viladecans (Barcelona); SILVIA MOLINA AGUILERA, Hospital d’Olot i Comarcal de la Garrotxa-Olot (Girona); ELENA MOLINS MILLAN, Hospital Mateu Orfila-Menorca; MARA DEL PILAR MARTNEZ OLONDRIS, Hospital Plató- Barcelona; JOSÉ SERRANO PARIENTE, Hospital de Inca-Mallorca; CRISTINA GÓMEZ GONZÁLEZ, Hospital General de la Defensa de Zaragoza- Zaragoza; MARTA PALOP CERVERA, Hospital de Sagunto- Sagunto (Valencia); JOSÉ ÁNGEL CARRETERO GARCA, Hospital Royo Villanova- Zaragoza; OSCAR BERNARDICH MÁRQUEZ, Hospital de Sant Joan de Déu-Manresa (Barcelona); FERNANDO JOSÉ SÁNCHEZ-TORIL LÓPEZ, Hospital Arnau de Vilanova-Valencia; JOAN SERRA BATLLES, Hospital General de Vic-Vic (Barcelona); CARMEN ABELEDO NÚÑEZ, Hospital Residència Sant Camil - Consorci Sanitari del Garraf-Sant Pere De Ribes (Barcelona); ENRIC BARBETA SÁNCHEZ, Hospital General de Granollers- Granollers (Barcelona); RICARDO PERIS I SÁNCHEZ, Hospital Francesc de Borja de Gandía-Gandía (Valencia); ALEJANDRO ROBLES PÉREZ, Hospital de Mataró-Mataró (Barcelona); ROSA MONTOLIU TARRAMERA, Hospital de Sant Joan Despí Moisès Broggi-L’Hospitalet de Llobregat (Barcelona); ANA I. GUTIERREZ RUBIO, Hospital General Universitario de Elda - Virgen de la Salud- Elda (Alicante); XAVIER AGUILAR BARGALLÓ, Hospital Universitari Joan XXIII de Tarragona- Tarragona; SALVADOR PONS VIVES, Hospital Son Llàtzer-Mallorca; JUSTO GRAU DELGADO, Hospital General Universitario de Elche-Elche (Alicante); EVA MARTNEZ MORAGÓN, Hospital Universitario Dr. Peset Aleixandre- Alicante; MARA PILAR AUSN HERRERO, Hospital del Mar-Barcelona; EBYMAR ARISMENDI NÚÑEZ, Hospital Clínic de Barcelona-Barcelona; CLEOFÉ FERNÁNDEZ ARACIL, Hospital General Universitario de Alicante- Alicante; CHRISTIAN DOMINGO, Hospital de Sabadell-Sabadell (Barcelona); FRANCISCO BORJA GARCA-COSO PIQUERAS, Hospital Universitario Son Espases, Mallorca; XAVIER MUÑOZ GALL, Hospital Universitari Vall d’Hebrón-Barcelona; ELISABET VERA SOLSONA, Hospital Universitario Miguel Servet-Zaragoza; GEMA CASTAÑO DE LAS POZAS, Hospital Comarcal de Jarrio-Asturias; SILVIA DORRONSORO QUINTANA, Hospital de Zumarraga-Guipúzcoa; MIGUEL ÁNGEL ALONSO FERNÁNDEZ, Hospital Vital Álvarez Buylla-Mieres (Asturias); ANA BUSTAMANTE RUIZ, Hospital Sierrallana-Torrelavega (Santander); JUAN ORTIZ DE SARACHO BOBO, Hospital El Bierzo-Ponferrada (León); IGNACIO LOBATO ASTIARRAGA, Complejo Asistencial de Ávila- Ávila; UXIO CALVO ÁLVAREZ, Complexo Hospitalario Universitario de Ferrol-Ferrol (A Coruña); MANUEL ÁNGEL MARTNEZ MUÑIZ, Hospital Universitario San Agustín-Avilés (Asturias); ANA ROSA EXPÓSITO VILLEGAS, Hospital de Cabueñes-Gijón (Asturias); ENRIQUE ALONSO MALLO, Complejo Asistencial Universitario de Palencia-Palencia; ANA BELLIDO MALDONADO, Complejo Hospitalario San Millán-San Pedro de La Rioja-Logroño; ANA CEREZO HERNÁNDEZ, Hospital Universitario Río Hortega-Valladolid; LUIS PÉREZ DE LLANO, Complexo Hospitalario Universitario de Lugo-Lugo; CORAL GONZÁLEZ FERNÁNDEZ, Complejo Hospitalario Universitario de Ourense-Ourense; ANA M^a PUEYO BASTIDA, Complejo Asistencial Universitario de Burgos-Burgos; BEATRIZ ABASCAL BOLADO, Hospital Universitario Marqués de Valdecilla-Santander; NURIA MARINA MALANDA, Hospital Universitario Cruces-Baracaldo (Vizcaya); JACINTO RAMOS GONZÁLEZ, Complejo Asistencial Universitario de Salamanca-Salamanca; LUIS CARAZO FERNÁNDEZ, Complejo Asistencial de León-León; PILAR CEBOLLERO RIVAS, Complejo Hospitalario de Navarra-Pamplona; MARINA BLANCO APARICIO, Complexo Hospitalario Universitario A Coruña-A Coruña; FRANCISCO JAVIER GONZÁLEZ BARCALA, Complejo Hospitalario Universitario de Santiago-Santiago de Compostela (A Coruña); BLANCA ALICIA HORTAL REINA, Hospital de Montilla-Montilla (Córdoba); JUAN MANUEL BRAVO SANTERVÁS, Hospital del Alto Guadalquivir-Andújar (Jaén); IRENE CASELLES GONZÁLEZ, Hospital Comarcal del Noroeste de la Región de Murcia- Caravaca de la Cruz (Murcia); JUAN SANTOS MORANO, Hospital Comarcal Riotinto-Minas de Riotinto (Huelva); FRANCISCO JOSÉ CABELLO RUEDA, Hospital Comarcal de la Serranía-Ronda (Málaga); BELÉN NAVAS BUENO, Hospital Comarcal Santa Ana-Motril (Granada); M^a DOLORES PÉREZ TEJERO, Hospital Comarcal Infanta Margarita-Cabra (Córdoba); JOSÉ CARLOS SERRANO REBOLLO, Complejo Hospitalario Llerena-Zafra-Zafra (Badajoz); ANA FULGENCIO DELGADO, Hospital Infanta Elena-Huelva; ANTONIA SOTO VENEGAS, Hospital Comarcal San Juan de la Cruz-Úbeda (Jaén); LEOPOLDO DAMIÁN DOMNGUEZ PÉREZ, Hospital Universitario de Ceuta-Ceuta; JOSÉ MARA CRUZ MOLINA, Hospital Comarcal San Agustín- Linares (Jaén); ALFONSO GARCA GUISADO, Hospital Don Benito-Villanueva de la Serena-Don Benito (Badajoz); ALICIA PADILLA GALO, Hospital Costa del Sol-Marbella (Málaga); FRANCISCO CASAS MALDONADO, Hospital Universitario Clínico San Cecilio-Granada; JOSÉ GREGORIO SOTO CAMPOS, Hospital de Especialidades de Jerez de La Frontera-Jerez de la Frontera (Cádiz); JAVIER GALLEGO BORREGO, Hospital Virgen de Valme-Sevilla; CAROLINA PUCHAES MANCHÓN, Hospital Juan Ramón Jiménez-Huelva; MANUEL AGUSTN SOJO GONZÁLEZ, Complejo Hospitalario de Cáceres-Cáceres; GUSTAVO VILLEGAS SÁNCHEZ, Complejo Hospitalario Torrecárdenas-Almería; ANA GÓMEZ-BASTERO FERNÁNDEZ, Hospital Universitario Virgen Macarena-Sevilla; CONCEPCIÓN MORALES GARCA, Hospital Universitario Virgen de las Nieves-Granada; JUAN JOSÉ MARTIN VILLASCLARAS, Complejo Hospitalario Regional de Málaga- Málaga; FRANCISCO JAVIER ÁLVAREZ GUTIÉRREZ, Hospital Universitario Virgen del Rocío- Sevilla.

Declaration of interest

Casas-Maldonado Francisco has received speaker fees, consulting fees or research grants from ALK, Astra-Zeneca, Bial, Boehringer-Ingelheim, Chiesi, CSL-Behring, GlaxoSmithKline, Grifols, Novartis, Sanofi, and Teva. Cisneros Carolina has received speaker fees, consulting fees or research grants from ALK, Astra-Zeneca, Chiesi, GlaxoSmithKline, Menarini, Mundipharma, Novartis, Sanofi, and Teva. Soto-Campos Jose-Gregorio has received speaker fees, consulting fees from ALK, Astra-Zeneca, Bial, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi, and Teva. Román Bernal, Berta has recieved speaker fees, consulting fees or research grants from Astra-Zeneca, Chiesi, Teva, Novastis, Menarini, Boehringer-Ingelheim, GlaxoSmithKline. Gonzalez-Barcala Francisco-Javier has received speaker fees, consulting fees or research grants from ALK, Astra-Zeneca, Bial, Boehringer-Ingelheim, Chiesi, Gebro Pharma, GlaxoSmithKline, Laboratorios Esteve, Menarini, Mundipharma, Novartis, Rovi, Roxall, Sanofi, Stallergenes-Greer and Teva.

Additional information

Funding

FORO AUTONOMICO DE ASMA-SEPAR (Spanish Respiratory Society).