Pre-biologic assessment of adherence in severe asthma and association with biologic continuation: a UK Severe Asthma Registry Study
Abstract
Background: Biologic therapies are approved for uncontrolled severe asthma despite good adherence to inhaled corticosteroids (ICS) and additional controllers. We examined the adherence assessments used across UK Severe Asthma Centres (SACs) and their relationship with biologic continuation and response.
Methods: UK SACs completed a quantitative survey on adherence assessment practices in 2022. We included all adult patients with severe asthma patients on ICS starting biologic therapy from the UK Severe Asthma Registry, which collects pre-biologic adherence data, including medication possession ratio (MPR), fractional exhaled nitric oxide (FeNO) suppression testing and serum prednisolone levels. Biologic continuation and response were defined as continuation on any biologic and the same biologic after 1 year, respectively. Associations were determined using multivariable logistic regression.
Results: At 21 SACs, MPR for ICS was assessed at 19 (90%) centres, prednisolone and/or cortisol levels in patients on daily oral corticosteroids at 15 (71%), and FeNO suppression testing at 9 (43%). Of 3307 biologic-initiated patients, 1943 (59%) had MPR for ICS recorded, of which 1802 (93%) demonstrated good adherence (≥75% MPR). Only 110 (9%) and 272 (16%) had FeNO suppression and serum prednisolone results, respectively. Good ICS adherence was associated with 2.65-fold higher odds (95% CI 1.02 to 6.91) of biologic continuation, but not with biologic response (OR 1.37, 95% CI 0.50 to 3.76).
Conclusion: Good pre-biologic ICS adherence, measured using MPR, is associated with biologic continuation at 1 year. Further research is needed to determine whether baseline adherence predicts biologic response based on clinical and biologic criteria.
Author
Yang, Freda
McDowell, Ronald
Busby, John
Murphy, Anna Claire
Patel, Pujan H
Jackson, David
Mansur, Adel H
Pfeffer, Paul E
Pantin, Thomas
Gore, Robin
Brown, Thomas
Naveed, Shamsa
Burhan, Hassan
Patel, Mitesh
Idris, Elfatih
Pavord, Ian
Subramanian, Deepak
Dodd, James William
Rupani, Hitasha
Chaudhuri, Rekha
Vyas, Aashish
Faruqi, Shoaib
Sammut, David
Message, Simon
Masoli, Matthew
Bloom, Chloe I
Heaney, Liam G
Siddiqui, Salman
McDowell, Ronald
Busby, John
Murphy, Anna Claire
Patel, Pujan H
Jackson, David
Mansur, Adel H
Pfeffer, Paul E
Pantin, Thomas
Gore, Robin
Brown, Thomas
Naveed, Shamsa
Burhan, Hassan
Patel, Mitesh
Idris, Elfatih
Pavord, Ian
Subramanian, Deepak
Dodd, James William
Rupani, Hitasha
Chaudhuri, Rekha
Vyas, Aashish
Faruqi, Shoaib
Sammut, David
Message, Simon
Masoli, Matthew
Bloom, Chloe I
Heaney, Liam G
Siddiqui, Salman
Date
2025-06-24
Type
Article
Subject
Asthma
Collections
Citation
Yang F, McDowell R, Busby J, Murphy AC, Patel PH, Jackson D, Mansur AH, Pfeffer PE, Pantin T, Gore R, Brown T, Naveed S, Burhan H, Patel M, Idris E, Pavord I, Subramanian D, Dodd JW, Rupani H, Chaudhuri R, Vyas A, Faruqi S, Sammut D, Message S, Masoli M, Bloom CI, Heaney LG, Siddiqui S; UK Severe Asthma Registry (UKSAR) investigators. Pre-biologic assessment of adherence in severe asthma and association with biologic continuation: a UK Severe Asthma Registry Study. BMJ Open Respir Res. 2025 Jun 24;12(1):e003019. doi: 10.1136/bmjresp-2024-003019.
Journal / Source Title
BMJ Open Respiratory Research
DOI
10.1136/bmjresp-2024-003019
PMID
40555553
Publisher
BMJ
British Thoracic Society
British Thoracic Society
Publisher’s URL
http://bmjopenrespres.bmj.com/