Most PCPs Unfamiliar With Biologic Therapy for Patients With Severe Asthma

Two posters presented at the American College of Allergy, Asthma and Immunology 2023 Annual Scientific Meeting discovered that most primary care physicians (PCPs) were unfamiliar with asthma biologics and that tezepelumab and dupilumab were the most initiated biologics.

Doctor writes prescription for asthma inhaler | Image Credit: © Goffkein - stock.adobe.com

The first poster aimed to understand PCP referral patterns and awareness of biologic therapy for uncontrolled asthma. Most patients with uncontrolled asthma living in the United States are treated by PCPs and not asthma specialists. Therefore, most individuals are being treated by someone who is likely not being frequently updated on asthma treatment advances, including biologics.¹

A survey-based descriptive study was administered by email to primary care attending and resident physicians through USF Health on PCP referral patterns to asthma specialists, their familiarity with asthma biologic therapy, and the use of laboratory values in asthma management.

A total of 85 PCPs were surveyed, of whom 77% referred patients to specialists after 2 or more exacerbations per year. Additionally, 42% were unfamiliar with biologics, 82% reported they do not get laboratory results, and 90% reported they do not use absolute eosinophil count to guide management.

Furthermore, the proportion of PCPs unfamiliar with biologics (P = .185) and their eligibility criteria (P = .383) did not vary based on the number of patients with asthma seen per month. Meanwhile, the frequency of PCP referrals to a specialist did not change familiarity with biologics (P = .260) or eligibility criteria (P = .393). However, PCPs who saw patients with asthma more frequently (P = .020) and referred patients to specialists (P = .029) were more likely to get lab work to manage asthma.

Therefore, the researchers believe that PCP education could increase biologic awareness and access and thus decrease asthma exacerbations.

The second poster aimed to describe trends in biologic initiation and switching among patients with severe asthma.²

The study is part of an ongoing, real-world, observational study of adults with severe asthma who receive biologics, maintenance system corticosteroids (SCS), or are uncontrolled on high-dosage inhaled CSC with additional controllers. Between February 2018 and February 2023, biologic initiation and switching were described by time interval based on biologic approval dates:

• Omalizumab on June 30, 2003
• Mepolizumab on November 4, 2015
• Reslizumab on March 23, 2016
• Benralizumab on November 14, 2017
• Dupilumab on October 19, 2018
• Tezepelumab on December 17, 2021

The researchers evaluated whether patients stopped, switched, or continued with one of these biologics, finding that out of a total of 3574 patients enrolled, 2687 (73%) had biologic use within the study period.

Compared with patients who continued biologics (n = 1794), patients who switched biologics (n = 529) were younger with a mean (SD) age of 52.3 (13.93) years, more likely to be seen by a pulmonologist, and more likely to have used maintenance SCS for 50% or more of the prior 12 months.

Additionally, benralizumab accounted for 72% of biologic switches between 2017 and 2018, followed by dupilumab, which accounted for 59% of switches in 2018 and 2019. Within the most recent time interval, tezepelumab (45%) and dupilumab (36%) accounted for the most common biologic switches from December 20, 2021, to February 28, 2023.

Furthermore, in this most recent time interval, tezepelumab (n = 34) and dupilumab (n = 27) were the most commonly initiated biologics.

References

1. Patel B, Bradford P, Flam B, et al. Primary care physician referral patterns and awareness of biologic therapy for uncontrolled asthma. Poster presented at: American College of Allergy, Asthma and Immunology 2023 Annual Scientific Meeting; November 9-13, 2023; Anaheim, CA.

2. Soong W, Panettieri RA, Carr WW, et al. Recent real-world biologic utilization among adults with severe asthma: data from the CHRONICLE study. Poster presented at: American College of Allergy, Asthma and Immunology 2023 Annual Scientific Meeting; November 9-13, 2023; Anaheim, CA.