Factors Related to Biologic Adherence and Outcomes Among Moderate-to-Severe Asthma Patients.
Factors Related to Biologic Adherence and Outcomes Among Moderate-to-Severe Asthma Patients.
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中度至重度哮喘患者的生物依从性和结果相关因素。
DOI：
10.1016/j.jaip.2022.05.022
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Bosworth,Hayden
中科院分区：
文献类型：
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作者：
Osazuwa-Peters,OyomoareL;Greiner,MelissaA;Oberle,Amber;Oakes,Megan;Thomas,SheilaM;Bosworth,Hayden
背景对于中重度哮喘患者，不同给药环境中哮喘生物制剂的依从性障碍可能并不相同。目的检查不同给药环境中哮喘生物制剂依从性和相关因素的差异，以及与 1 年全因急诊科 (ED) 就诊的关系。方法对 2016 年 1 月 1 日至 4 月 30 日期间接受初始生物治疗的中重度哮喘患者进行回顾性研究， 2020年，在Optum Clinformatics数据集市进行。确定了三种给药设置：仅诊所（门诊办公室/输液中心）、家庭（自我给药）和混合设置（诊所和自我给药的混合）。哮喘生物制剂依从性是指初始治疗后 6 个月内观察到的生物制剂剂量与预期的生物制剂剂量的比例。使用泊松回归分析，通过给药设置确定与依从性相关的因素。使用 Cox 回归分析评估每种给药环境的 1 年全因急诊就诊与依从性之间的关系。结果 研究队列有 3932 名患者。在临床环境（最常见的给药环境）中，生物制剂的依从性为 0.75 [0.5, 1]，在家庭和混合环境中为 0.83 [0.5, 1]。在某些情况下，专家的访问始终与更好的生物依从性相关，而黑人种族、西班牙裔、较低的教育程度、仅限医疗保险和较高的患者自付费用与较差的生物依从性相关。在混合环境中，一年全因急诊就诊的风险随着生物制剂的依从性而降低。结论哮喘生物制剂的依从性因给药环境而异。提高哮喘生物制剂依从性的努力应考虑在有益时促进自我给药，改善先前的专家就诊机会，并针对依从性不佳风险较高的患者，特别是黑人和西班牙裔患者。
BackgroundAdherence barriers to asthma biologics may not be uniform across administration settings for patients with moderate-to-severe asthma.ObjectiveTo examine differences in asthma biologic adherence and associated factors, as well as association with a 1-year all-cause emergency department (ED) visit, across administration settings.MethodsA retrospective study of biologic naïve moderate-to-severe asthma patients with initial biologic therapy between January 1, 2016, and April 30, 2020, in the Optum Clinformatics Data Mart was performed. Three administration settings were identified: Clinic-only (outpatient office/infusion center), Home (self-administration), and Hybrid setting (mixture of clinic and self-administration). Asthma biologic adherence was the proportion of observed over expected biologic dose administrations received within 6 months from initial therapy. Factors associated with adherence were identified by administration setting, using Poisson regression analyses. A relationship between a 1-year all-cause ED visit and adherence was assessed for each administration setting using Cox regression analyses.ResultsThe study cohort was 3932 patients. Biologics adherence was 0.75 [0.5, 1] in Clinic setting, the most common administration setting, and 0.83 [0.5, 1] in both Home and Hybrid settings. Specialist access was consistently associated with better biologic adherence, whereas Black race, Hispanic ethnicity, lower education, Medicare only insurance, and higher patient out-of-pocket cost were associated with worse biologic adherence in some settings. In the Hybrid setting, hazard for a 1-year all-cause ED visit decreased with biologic adherence.ConclusionsAsthma biologic adherence varied by administration setting. Efforts to improve asthma biologic adherence should consider promoting self-administration when beneficial, improving prior specialist access, and targeting patients with higher risk of suboptimal adherence particularly Black and Hispanic patients.