Study: In Severe Asthma, Benefits of At-Home Biologics Outweigh Disadvantages

A new study of patients with severe asthma from 4 countries suggests patients were optimistic about the benefits of home administration of biologic therapies, but they also need easily accessible support from health care providers.

The report was published in the Journal of Allergy and Clinical Immunology: In Practice.

Corresponding author Bertine Flokstra-de Blok, PhD, of the General Practitioners Research Institute in the Netherlands, and colleagues said patients with severe asthma face higher risks of hospitalization, comorbidities, disease burden, and mortality. But the investigators wrote that new biologic therapies have led to significant improvements for these patients. The problem, they said, is that biologics also come with certain challenges.

“Unlike the standard pharmacotherapy for airways disease (inhaled or oral), the predominant mode of administration of biologics is systemic (subcutaneous or intravenous) by health care providers,” they wrote. “Consequently, hospital- or office-based administration was potentially a barrier to biologics for eligible patients.”

One way drug-makers have sought to overcome those barriers is by developing self-injection devices and pre-filled syringes that empower patients to administer their own biologics at home.

Severe asthma therapies available for at-home administration include benralizumab, dupilumab, mepolizumab and omalizumab. The drugs are typically administered in 2-week or 8-week intervals, the authors said.

Although at-home administration would appear to provide significant convenience to patients, the investigators wanted to know what patients and physicians thought of the idea in practice.

To find out, they convened online forums and focus groups in 4 countries: the Netherlands, the United States, Australia, and the United Kingdom. Seventy-five people participated in the online forums, and 40 of those people attended the focus groups. Two focus groups were held in each country, one with potential or new users of at-home biologics, and one with experienced users of at-home biologics. The authors also held interviews with health care providers.

Patients who had used at-home biologics said they appreciated the convenience of not having to travel to a clinic or a hospital, and the health care providers interviewed said they preferred patients be able to administer the drugs at home whenever feasible. However, patients sometimes favored the safety of human contact associated with in-clinic administration, and some patients’ insurers would only cover the drug if it were administered by a health care professional.

Patients said they generally received clear instructions on how to use their injection devices, a process that typically included practice injections at their health care facility. Patients also said they were mostly able to adhere to their injection schedules, a finding confirmed by the health care provider interviews.

When it came to side effects, Flokstra-de Blok and colleagues said some patients had a clear and precise understanding of potential side effects and of side effects they personally had experienced. However, others expressed confusion about whether side effects were drug-related or related to comorbid conditions or other life stressors. Patients said their health care providers had given them information about potential side effects, although some still worried about long-term side effects, given the newness of the therapies.

Summarizing their findings, the investigators said health care providers play a key role in the success of home-administered biologics. It is important that they provide both verbal and written instruction, so patients have a record when they return home, as well as in-clinic demonstrations, the investigators said. They may also need to help arrange reimbursement for biologics, although some of the patients’ insurers denied coverage even with a physician recommendation. Lastly, the authors said health care providers should be vigilant about monitoring patients, both because of the potential for side effects and because some patients will miss the in-person contact associated with clinic visits.

If those conditions are met, Flokstra-de Blok and colleagues said, at-home biologics can be a significant improvement for patients with severe asthma.

“Overall, this study showed that the benefits of home administration of biologics usually outweigh the disadvantages and side effects,” they concluded.

Reference:

Flokstra-de Blok B, Kocks J, Wouters H, et al. Perceptions on home-administration of biologics in the context of severe asthma: an international qualitative study. J Allergy Clin Immunol Pract. Published online April 26, 2022. doi:10.1016/j.jaip.2022.04.015