Factors Associated With Increased Asthma Exacerbations After Stopping Biologic Treatment

There is limited information about factors that are associated with outcomes after stopping asthma biologics. Individuals who stopped asthma biologics after at least 6 months of treatment were identified in a large insurance database from 2003-2019. The primary outcome used to assess failure after stopping treatment was an increase of 50% or more in the asthma exacerbation rate after the first 6 months after stopping treatment compared to the 6 month period before biologic initiation. Asthma exacerbations were defined as hospitalization with a primary diagnosis of asthma or in a secondary position with a respiratory diagnosis in the first position, emergency department visit with a primary diagnosis of asthma, or a pharmacy fill for a systemic corticosteroid within 1 month of an outpatient visit. Characteristics associated with a decreased odds of failure after stopping treatment were lack of pulmonologist or allergist visits (OR [95% CI]: 0.273 [0.127, 0.586]) and the number of Charlson Conditions 0-1 vs. 4+ (0.645 [0.445, 0.936]). Sex, age, and insurance type were not associated with failure after stopping biologic treatment. People with asthma receiving biologic therapy were less likely to experience increased asthma exacerbations after stopping therapy if they had not seen an asthma specialist during the 6 months before treatment initiation or if they had a decreased number of comorbid conditions. This may suggest their biologic treatment was not intended to treat asthma; alternatively, this may reflect suboptimal patient selection for biologic treatment when an asthma specialist is not part of the treatment decision.