Comparative Impact of Asthma Biologics - A Nationwide US Claim-Based Analysis.

BACKGROUND: Biologic modifiers targeting type-2 (T2) airway inflammation are effective in reducing asthma exacerbation, however real-world and comparative effectiveness studies remain limited.

OBJECTIVE: to examine and compare the real-world impact of anti-T2 asthma biologics METHODS: In this retrospective new user cohort study, we used the MarketScan, a Commercial Claims and Encounters Database, to identify adult patients with asthma who were started on an anti-T2 biologic agent (anti-IL-5s, dupilumab or omalizumab). We examined the influence of the biologic class on asthma exacerbation by comparing the average number of asthma exacerbation 1-year pre- and post-biologic initiation. We conducted multivariable regression analyses to compare the effectiveness of these asthma biologics on reducing the incidence of asthma exacerbations within 18-month of initial administration of biologics while controlling for demographic variables, comorbidities, and asthma severity.

RESULTS: We identified 5,538 asthma patients who were initiated on an anti-T2 biologic [mean age (±SD); 45.6 (12.78) years; % females, 65.8%). Asthma biologics reduced asthma exacerbation by 11-47%, particularly among patients with 2+ asthma exacerbations in the year preceding biologic initiation (31-65% reduction). Biologics were especially effective in reducing asthma-related hospitalizations (44.6-60%). After adjusting for baseline demographics, asthma medication, and co-morbidities, dupilumab was associated with a lower estimated mean number of asthma exacerbation per year and lower adjusted OR for developing asthma exacerbation relative to other biologics (50-80% less likely).

CONCLUSION: Anti-T2 asthma biologics reduced asthma exacerbation in real-word settings. Evidence supports growing literature that dupilumab might have a more favorable impact on asthma exacerbation relative to other asthma biologics.