Queen's University Belfast

Academic Institute

Dr John Busby

E070

Asthma is a common condition affecting around 182,000 patients in Northern Ireland. Around 5% of these are severe asthmatics who remain uncontrolled despite taking high-dose inhaled corticosteroids. These patients suffer a substantial morbidity burden, including frequent exacerbations, and are managed within the Belfast City Hospital Difficult Asthma Service. Recently, several new biologic therapies have been licensed for use in severe asthma. These have been shown to be highly effective in clinical trials, however some patients do not respond to treatment despite having susceptible biology. Identifying and, if possible, addressing the reasons for non-response is crucial to ensure that these high-cost medications are efficiently utilised. Non-adherence to maintenance treatment is a common problem within asthma. Several factors have been associated with non-adherence including beliefs around the necessity of taking treatment. Given the profound effect of biologic medications on asthma symptoms, there is some concern that patients may consider their maintenance treatment to be less necessary, and therefore reduce adherence following biologic initiation with downstream effects on treatment response. Furthermore, little is known about the comorbidity profile of patients receiving biologic treatment within the UK as the randomised controlled trials which informed clinical practice generally excluded patients with other diseases. Consequently, the effect of comorbidities on treatment response remains unclear. The primary aim of this study is to investigate the effect of biologic initiation on maintenance asthma medication adherence. Its secondary aims are to characterise patients receiving biologics, and explore the impact of non-adherence and comorbidities on biologic response through linkage to primary care data.

The use of biologic therapies among Northern Irish severe asthmatics is increasing rapidly as several new medicines are brought to market. It is crucial that the benefit from these high-cost medications is maximised. The first-step to achieving this is to investigate if patients are routinely reducing their maintenance medication adherence following biologic initiation, and to what extent this reduced adherence effects treatment response. Consistent findings of lower adherence among patients who believe their treatment to be less necessary suggests this is plausible; however this hypothesis has yet to be examined in real-world data. If we find that this is a common problem within Northern Ireland, it would provide strong evidence for the introduction of adherence improvement interventions, such as motivational interviewing or electronic inhaler monitoring, upon commencement of biologic therapies. Our examination of which types of patients are more likely to lapse will allow these to be precisely targeted. Investigating the extent to which non-adherent patients are able to access biologic therapy will highlight weaknesses in current screening processes with the Belfast City Hospital Difficult Asthma Service and could support the introduction of more stringent adherence checks including FeNO suppression testing. This could lead to significant population benefits for Northern Irish severe asthmatics through more precise targeting of scarce biologic medications and reduced waiting lists. Lastly, this study will be the first to comprehensively detail the comorbidity profile of biologic patients and explore how these affect treatment response. This provides an excellent starting point for future research in this area which could lead to downstream benefits for Health and Social Care.

21/09/2021

TRE