Why Don’t More Patients with Asthma Use Biologicals?

Last month, I shared several videos with you that pertained to treatment of #asthma with biologicals. I hope you listened to the lives of patients just like you who can now “do life” with their family and friends not having to fear the next asthma attack. But it’s not so easy to change our habits on treating asthma. We’ve been trying for years to get patients to use preventative care (ie, inhaled steroids) and that method even in clinical studies is no more than ~50% effective. So what’s next?

You would think that such an advance in the treatment of asthma (without steroids) would become the cat’s meow and everyone would be using them. According to a study published this year, this is not the trend we’re seeing.

I have to put my nerd hat on every so often and talk about a study that analyzes asthma care. (Inselman Jw, et al: Trends and disparities in asthma biologic use in the United States. J Allergy Clin Immunol Pract. 8: 549-554, 2020) Often, researchers will identify and study patients with insurance claims for asthma medication, because the data is more readily available. In this case, investigators looked at claims from 2003 and 2018. They found biologic use in 6,642 individuals and analyzed their use over time.

This is what I usually use! Not good enough any more.

They found the following:

  • Most use of biologics peaked in 2006, which means the use is now decreasing.
  • Four new agents have hit the streets since 2015 and we still can’t get more use out of these valuable agents. (Nucala, Cinqair, Fasenra, Dupixent)
  • What makes you more likely to use a biological: Age 18 to 64, Asian race/ethnicity, household income > $40,000, West region, commercial insurance, and access to specialist.
  • Who prescribes biologicals:
    • 56% allergiest
    • 35% pulmonologists
    • 9% family practitioners
  • 9.5% of clinicians prescribed 29.5% of incident uses, meaning there is a small group of clinicians writing a disproportinately high number of biologic prescriptions.

Overall, a small overall use of asthma biologics, disparities in access to these agents, and a concentration of prescriptions by a small group of clinicians.

So how do I deal with with uncontrolled asthma knowing that medications such as biologicals are available? I make sure you know about the following:

Biologics are not all the same, but I can usually find the one that fits your condition the best. Remember, we have 4 to choose from, and if one doesn’t work, we can usually get insurance approval for an alternative.

Wouldn’t it be nice to only have to use a medication for your asthma once every 2-4 weeks? I thought you might like that idea, and I would certainly discuss the best alternatives for your asthma.

How in the world can I afford this new medication? Fortunately, all of the companies producing biologics have great patient assistance programs and @ Warren Clinic allergy, we have one of the best prior authorization specialists to get the job done.

The cold and flu season (not to mention COVID-19) is here and often your asthma will increase during the winter months. No sense in using unnecessary steroids or suffering from uncontrolled asthma during the holidays.

Speaking of cold and flu season, don’t forget your flu shot, and enjoy the beauty of the Fall season!

Peak autumn foliage in the Monadnock Region of New Hampshire

#american-academy-of-allergy-asthma-and-immunology, #american-college-of-allergy-asthma-immunology, #biologics