Clinical Outcomes Of Biologic Therapy On Asthma In A Medically Underserved Urban Population

Asthma is a heterogeneous disease that disproportionately affects urban populations. Uncontrolled and severe asthma necessitates frequent healthcare utilization. Biologic therapies are clinically efficacious in asthma control, but there is still an unmet need. This study evaluated the clinical outcomes of biologic therapy in moderate-to-severe persistent asthma in a population with restricted medical care access. We evaluated 65 patients with moderate-to-severe persistent asthma that were on mepolizumab (n=33), omalizumab (n=18), dupilumab (n=5), or benralizumab (n=3). We collected demographic information, evaluated symptom control and healthcare utilization for 12 months prior to and for 12 months after initiating biologic therapy. Independent t-test was used to assess statistical significance. Our cohort was predominantly African American (49%) and Hispanic (27%). Forty-nine percent lived in impoverished communities without insurance (41%), and among those with insurance, 69% had managed Medicaid. Patients on biologic therapy had significantly less acute care visits (2 vs 0.6 visits, p<0.001), hospitalizations (1.1 vs 0.3 admissions, p=0.001), routine provider visits (9.8 vs 8 visits, p=0.03) and prednisone courses (4.2 vs 1.8, p<0.001) as well as higher peak flow values (288 vs 347, p=0.01) and asthma control test (ACT) scores (10.8 vs 17.3, p<0.001). Side effect profile was favorable. Our study found and confirmed that biologic therapies for moderate-to-severe persistent asthma decreased medical utilization, systemic corticosteroid reliance, and showed a marked reduction in frequency of exacerbations. Asthma morbidity and mortality reduction with biologic therapies through medication assistance programs may ease disease burden and health disparities in high risk urban populations.