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
National Heart and Lung Institute, Imperial College London, London, UK
Administrative Data Research Centre - Northern Ireland, Department of Psychology, Ulster University, Coleraine, UK.
BMJ Open Respir Res. 2025 Jun 24;12(1):e003019. doi: 10.1136/bmjresp-2024-003019.
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.
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.
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).
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.
尽管患者已良好坚持吸入糖皮质激素（ICS）及其他控制药物，但生物制剂疗法仍被批准用于治疗控制不佳的重度哮喘。我们研究了英国重度哮喘中心（SACs）所采用的依从性评估方法及其与生物制剂持续使用和疗效的关系。
英国SACs在2022年完成了一项关于依从性评估实践的定量调查。我们纳入了英国重度哮喘登记处所有开始接受生物制剂治疗的重度哮喘成年患者，该登记处收集了生物制剂治疗前的依从性数据，包括药物持有率（MPR）、呼出一氧化氮分数（FeNO）抑制试验和血清泼尼松龙水平。生物制剂的持续使用和疗效分别定义为持续使用任何生物制剂和在1年后持续使用同一种生物制剂。采用多变量逻辑回归确定相关性。
在21个SACs中，19个（90%）中心评估了ICS的MPR，15个（71%）中心评估了每日口服糖皮质激素患者的泼尼松龙和/或皮质醇水平，9个（43%）中心进行了FeNO抑制试验。在3307例开始使用生物制剂的患者中，1943例（59%）记录了ICS的MPR，其中1802例（93%）显示依从性良好（MPR≥75%）。分别只有110例（9%）和272例（16%）有FeNO抑制试验和血清泼尼松龙结果。良好的ICS依从性与生物制剂持续使用的几率高2.65倍相关（95%CI 1.02至6.91），但与生物制剂疗效无关（OR 1.37，95%CI 0.50至3.76）。
使用MPR衡量的生物制剂治疗前良好的ICS依从性与1年后生物制剂的持续使用相关。需要进一步研究以确定基于临床和生物学标准的基线依从性是否可预测生物制剂疗效。
