Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data

Shackleford, Amy; Heaney, Liam G.; McDowell, P. Jane; Davies, Gwyneth; Butler, Claire; Sweeney, Joan; Busby, John

doi:10.1016/j.jaip.2025.06.029

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Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data

Amy Shackleford

, Liam G. Heaney, P. Jane McDowell, Gwyneth Davies

, Claire Butler, Joan Sweeney, John Busby

The Journal of Allergy and Clinical Immunology: In Practice, Volume: 13, Issue: 10, Pages: 2626 - 2633.e8

Swansea University Author: Gwyneth Davies

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DOI (Published version): 10.1016/j.jaip.2025.06.029

Abstract

Background: Poor adherence to inhaled therapy is common among patients with asthma. Findings from previous studies exploring inhaled corticosteroid (ICS) adherence in biologic-treated populations are inconsistent and have not investigated the long-term outcomes. Objective: To assess the long-term im...

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Published in:	The Journal of Allergy and Clinical Immunology: In Practice
ISSN:	2213-2201 2213-2198
Published:	Elsevier BV 2025
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa70392

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last_indexed	2025-10-24T18:37:03Z
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Objective: To assess the long-term impact of introducing biologics on ICS/long-acting β2-agonist (LABA) adherence and to investigate the effect of poor ICS/LABA adherence on clinical outcomes among biologic-treated patients. Methods: A retrospective cohort study of adults who attended the Northern Ireland Regional Severe Asthma center between September 2015 and November 2021 was performed. Medication possession ratios (MPRs) for ICS/LABA medication were calculated using community dispensing records. Good adherence was defined as an MPR ≥75%. We compared adherence before and after biologic initiation, examined the correlates of adherence, and used multivariable longitudinal models to assess the impact of adherence on asthma outcomes. Results: Of 207 included patients, 58 (28.0%) had suboptimal adherence before biologic initiation. This was associated with higher deprivation (43.1% vs 25.2%; P = .012) and fractional exhaled nitric oxide (50 vs 32 parts per billion; P = .043). Population-level MPRs were stable during the study; however, adherence varied for individual patients. A total of 69 (33.3%) patients had poor adherence 1 year after biologic initiation. Although a substantial reduction in exacerbation rates was seen for both groups after biologic initiation, those with good adherence had an additional 17.4% (95% confidence interval: 2.2%, 30.2%) reduction in exacerbations compared with those with poor adherence. We found no difference in asthma symptoms or lung function. Conclusions: The introduction of biologics had little impact on population-level adherence; however, there were substantial changes for individual patients. 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spelling	2025-10-23T14:50:38.4862848 v2 70392 2025-09-18 Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data 92d69cf8519a334ced3f55142c811d95 0000-0003-1218-1008 Gwyneth Davies Gwyneth Davies true false 2025-09-18 MEDS Background: Poor adherence to inhaled therapy is common among patients with asthma. Findings from previous studies exploring inhaled corticosteroid (ICS) adherence in biologic-treated populations are inconsistent and have not investigated the long-term outcomes. Objective: To assess the long-term impact of introducing biologics on ICS/long-acting β2-agonist (LABA) adherence and to investigate the effect of poor ICS/LABA adherence on clinical outcomes among biologic-treated patients. Methods: A retrospective cohort study of adults who attended the Northern Ireland Regional Severe Asthma center between September 2015 and November 2021 was performed. Medication possession ratios (MPRs) for ICS/LABA medication were calculated using community dispensing records. Good adherence was defined as an MPR ≥75%. We compared adherence before and after biologic initiation, examined the correlates of adherence, and used multivariable longitudinal models to assess the impact of adherence on asthma outcomes. Results: Of 207 included patients, 58 (28.0%) had suboptimal adherence before biologic initiation. This was associated with higher deprivation (43.1% vs 25.2%; P = .012) and fractional exhaled nitric oxide (50 vs 32 parts per billion; P = .043). Population-level MPRs were stable during the study; however, adherence varied for individual patients. A total of 69 (33.3%) patients had poor adherence 1 year after biologic initiation. Although a substantial reduction in exacerbation rates was seen for both groups after biologic initiation, those with good adherence had an additional 17.4% (95% confidence interval: 2.2%, 30.2%) reduction in exacerbations compared with those with poor adherence. We found no difference in asthma symptoms or lung function. Conclusions: The introduction of biologics had little impact on population-level adherence; however, there were substantial changes for individual patients. Good adherence to ICS/LABA was associated with lower exacerbation rates among biologic-treated patients with severe asthma. Journal Article The Journal of Allergy and Clinical Immunology: In Practice 13 10 2626 2633.e8 Elsevier BV 2213-2201 2213-2198 Asthma; Treatment adherence and compliance; Biological therapy 1 10 2025 2025-10-01 10.1016/j.jaip.2025.06.029 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee 2025-10-23T14:50:38.4862848 2025-09-18T11:37:48.8078865 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Amy Shackleford 0009-0001-8922-7644 1 Liam G. Heaney 2 P. Jane McDowell 3 Gwyneth Davies 0000-0003-1218-1008 4 Claire Butler 5 Joan Sweeney 6 John Busby 7 70392__35455__5a971b05eb9542428196cbfa2cfabc1e.pdf 70392.VOR.pdf 2025-10-23T14:47:03.1925493 Output 1238589 application/pdf Version of Record true © 2025 The Authors. This is an open access article distributed under the terms of the Creative Commons CC-BY license. true eng http://creativecommons.org/licenses/by/4.0/
title	Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data
spellingShingle	Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data Gwyneth Davies
title_short	Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data
title_full	Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data
title_fullStr	Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data
title_full_unstemmed	Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data
title_sort	Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data
author_id_str_mv	92d69cf8519a334ced3f55142c811d95
author_id_fullname_str_mv	92d69cf8519a334ced3f55142c811d95_***_Gwyneth Davies
author	Gwyneth Davies
author2	Amy Shackleford Liam G. Heaney P. Jane McDowell Gwyneth Davies Claire Butler Joan Sweeney John Busby
format	Journal article
container_title	The Journal of Allergy and Clinical Immunology: In Practice
container_volume	13
container_issue	10
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publishDate	2025
institution	Swansea University
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doi_str_mv	10.1016/j.jaip.2025.06.029
publisher	Elsevier BV
college_str	Faculty of Medicine, Health and Life Sciences
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description	Background: Poor adherence to inhaled therapy is common among patients with asthma. Findings from previous studies exploring inhaled corticosteroid (ICS) adherence in biologic-treated populations are inconsistent and have not investigated the long-term outcomes. Objective: To assess the long-term impact of introducing biologics on ICS/long-acting β2-agonist (LABA) adherence and to investigate the effect of poor ICS/LABA adherence on clinical outcomes among biologic-treated patients. Methods: A retrospective cohort study of adults who attended the Northern Ireland Regional Severe Asthma center between September 2015 and November 2021 was performed. Medication possession ratios (MPRs) for ICS/LABA medication were calculated using community dispensing records. Good adherence was defined as an MPR ≥75%. We compared adherence before and after biologic initiation, examined the correlates of adherence, and used multivariable longitudinal models to assess the impact of adherence on asthma outcomes. Results: Of 207 included patients, 58 (28.0%) had suboptimal adherence before biologic initiation. This was associated with higher deprivation (43.1% vs 25.2%; P = .012) and fractional exhaled nitric oxide (50 vs 32 parts per billion; P = .043). Population-level MPRs were stable during the study; however, adherence varied for individual patients. A total of 69 (33.3%) patients had poor adherence 1 year after biologic initiation. Although a substantial reduction in exacerbation rates was seen for both groups after biologic initiation, those with good adherence had an additional 17.4% (95% confidence interval: 2.2%, 30.2%) reduction in exacerbations compared with those with poor adherence. We found no difference in asthma symptoms or lung function. Conclusions: The introduction of biologics had little impact on population-level adherence; however, there were substantial changes for individual patients. Good adherence to ICS/LABA was associated with lower exacerbation rates among biologic-treated patients with severe asthma.
published_date	2025-10-01T05:30:45Z
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Investigating the Association Between Biologic Initiation and Medication Adherence in Severe Asthma: An Analysis of Linked Data

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