Arijita Deb

Introduction Mepolizumab and dupilumab are biologic therapies used to manage uncontrolled asthma, though direct comparative real-world evidence between these two agents is limited. This study compared asthma-related hospitalizations and asthma exacerbations between mepolizumab and dupilumab among an older and clinically complex population of Medicare fee-for-service (FFS) beneficiaries with asthma. Methods Data from Komodo Research Database (01/01/2018–05/31/2025) were used to identify Medicare FFS beneficiaries with asthma and a first claim for mepolizumab or dupilumab on or after January 1, 2019 (index date), as well as a subgroup of patients adherent to the index biologic for ≥ 6 months. Cohorts were balanced using overlap weighting based on a propensity score model. Rates of asthma-related hospitalizations and asthma exacerbations were evaluated while on treatment as the number of events per patient-year (PPY) and compared between weighted cohorts using rate ratios (RRs) with 95% confidence intervals (CIs). Rates of asthma-related hospitalizations were assessed for non-inferiority using a fixed-margin approach. Results Overall, 1055 and 1218 patients were included in the mepolizumab and dupilumab cohorts, respectively (mean age 70.1 and 67.4 years). Baseline characteristics were well balanced after weighting. Mepolizumab demonstrated non-inferiority to dupilumab for asthma-related hospitalizations within the overall population (RR 0.71, 95% CI 0.46, 1.08; p = 0.113; non-inferiority margin 1.10) and superiority to dupilumab within the adherent subgroup (RR 0.54, 95% CI 0.30, 0.99; p = 0.047). Mepolizumab was also associated with significantly lower rates of asthma exacerbations than dupilumab in the overall population (RR 0.85, 95% CI 0.72, 1.00; p = 0.047) and directionally favorable rates in the adherent subgroup (RR 0.82, 95% CI 0.63, 1.05; p = 0.116). Conclusions Among Medicare FFS beneficiaries, mepolizumab demonstrated comparable real-world effectiveness to dupilumab for asthma-related hospitalizations and was associated with significantly lower rates of asthma exacerbations, supporting mepolizumab as an effective treatment option for older, clinically complex patients with asthma.

This study describes factors associated with biologic initiation and adherence, and impacts of adherence on exacerbations among US patients with severe asthma. This retrospective cohort study defined two populations, biologic-eligible patients and biologic users, using the Komodo Research Database of healthcare claims (2016–2024). The biologic-eligible cohort was defined as patients with severe asthma who had ≥2 exacerbations within 12 months, after the severe asthma index date. Severe asthma was defined as ≥3 month medium-to-high-dose inhaled corticosteroid use with ≥1 overlapping supply with controller therapy. The severe asthma index date was the first day of overlapping treatment supply. Biologic users were defined as patients with ≥2 dispensings of the same biologic and ≥2 asthma diagnoses in the year prior to biologic initiation. In the biologic-eligible cohort, biologic initiation was evaluated and compared between less- and more-favored social determinants of health (SDOH) areas (based on census-level quartiles). Adherence (assessed based on refills and treatment gaps) and exacerbations were assessed among biologic users in the 12 months following biologic initiation and compared between less- and more-favored SDOH areas. Overall 29,652 patients had ≥2 years of follow-up in the biologic-eligible cohort. Of these, 11.3% (n=3362) initiated biologics. In total, 16,336 patients were included in the biologic-user cohort, among whom 62.6% were adherent, 12.1% partially adherent, 3.1% minimally adherent, and 22.3% discontinued treatment. Biologic initiation and adherence were lower in less- versus more-favored SDOH areas. Compared with adherent patients, those who were partially/minimally adherent or discontinued treatment in the 12 months following biologic initiation had significantly more exacerbations post-landmark period (+18% overall and +28% hospitalization-defined exacerbations). Disparities in biologic initiation and adherence exist between severe asthma populations with different characteristics and SDOH. Biologic adherence is associated with fewer exacerbations compared with partial adherence, minimal adherence, and treatment discontinuation.

Background: Patients with asthma with an eosinophilic phenotype may be eligible for additional treatment options to improve disease control; however, the prevalence and frequency of eosinophil testing is unknown. This study assessed blood eosinophil count testing prevalence in patients with asthma by exacerbation frequency and healthcare provider (HCP) type. Methods: This was a retrospective, longitudinal, real-world study (GSK ID: 214470) utilizing the Merative Explorys^® Universe electronic health records database. Eligible patients had ≥ 2 asthma diagnostic codes (January 2016–December 2018) (Index date: first asthma diagnosis). Outcomes included patient demographics and clinical characteristics (12 months pre-index [baseline]), and prevalence of blood eosinophil count testing, stratified by exacerbation frequency (infrequent exacerbations [< 2]) or frequent exacerbations [≥ 2] or primary HCP (Allergist/Pulmonologist, a primary care physician [PCP] or other HCP) during the 12 months post-index (follow-up). Results: Of 400,254 patients included (mean age: 51.2 years; 70.8% female), the most common provider type at baseline was a PCP (76.8%). A higher proportion of patients with frequent exacerbations had blood eosinophil count tests at baseline (55.4–69.5%) and follow-up (67.9–75.1%), compared with patients with infrequent exacerbations (55.5–63.7%, 62.4–67.3%). Significantly more patients in the Allergist/Pulmonologist subgroup had ≥ 1 blood eosinophil count test result compared with patients in the PCP subgroup at both baseline (59.9% vs. 50.7%; p < 0.001) and follow-up (59.0% vs. 56.2%; p < 0.001). In the total population, the mean (SD) number of tests ordered was 3.4 (5.3) and 4.1 (6.4) during the baseline and follow-up periods, respectively. A greater mean number of tests were ordered for patients with frequent exacerbations, most apparently in the Allergist/Pulmonologist subgroup during baseline and follow-up (7.4 vs. 4.9). For patients with frequent exacerbations and blood eosinophil count test results, the mean (SD) number of tests ranged from 3.1 (4.6) to 5.8 (8.3) at baseline and 5.1 (8.5) to 7.4 (10.6) during follow-up. Conclusions: The prevalence of blood eosinophil count testing in patients with asthma remains suboptimal. Routine blood eosinophil count testing should be considered by HCPs for patients with asthma to increase identification of the eosinophilic asthma phenotype, which may inform the decision to advance to targeted biologic therapy.

Background: Systemic corticosteroid (SCS) use remains widespread among patients with severe asthma, despite associated complications. Objective: Evaluate the association between cumulative SCS exposure and SCS-related complications in severe asthma. Methods: This retrospective, longitudinal study used claims data from the Optum Clinformatics Data Mart database (GSK ID: 214469). Eligible patients (≥ 12 years old) had an asthma diagnosis and were divided into two cohorts: SCS use and non/burst-SCS use. Patients in the SCS use cohort had a claim for a daily prednisone-equivalent dose ≥ 5 mg SCS following ≥ 6 months of continuous SCS use; those in the non/burst-SCS cohort had no evidence of continuous SCS use and had a non-SCS controller/rescue medication initiation claim. For each cohort, the date of the qualifying claim was the index date. SCS users were further stratified by SCS use during each quarter of follow-up: low (≤ 6 mg/day), medium (> 6–12 mg/day), high (> 12 mg/day), and continuous high (≥ 20 mg/day for 90 days). SCS-related complications were evaluated in the quarter following SCS exposure. The adjusted odds ratios (OR) of experiencing SCS-related complications during follow-up in each of the SCS use groups versus the non/burst SCS cohort were calculated using generalized estimating equations models. Results: SCS and non/burst-SCS use cohorts included 7473 and 89,281 patients (mean follow-up: 24.6 and 24.2 months), respectively. Compared with the non/burst-SCS use cohort, medium, high, and continuous high SCS use was associated with greater odds of any SCS-related complication (adjusted OR [95% confidence interval]: 1.30 [1.21, 1.39], 1.49 [1.35, 1.64] and 1.63 [1.40, 1.89], respectively) including increased acute gastrointestinal, cardiovascular, and immune system-related complications, and chronic cardiovascular, metabolic/endocrine, central nervous system, bone-/muscle-related, ophthalmologic, and hematologic/oncologic complications. Low-dose SCS use was also associated with significantly increased odds of acute gastrointestinal and immune system-related complications, and chronic bone-/muscle-related and hematologic/oncologic complications versus the non/burst-SCS use cohort. Conclusion: SCS use, even at low doses, is associated with increased risk of SCS-related complications among patients with severe asthma.

Purpose: Real-world data on mepolizumab in patients with severe asthma and allergic and non-allergic phenotypes are limited. This study investigated the effectiveness of mepolizumab treatment in patients with severe asthma with allergic and non-allergic phenotypes. Patients and Methods: This retrospective cohort study (GSK ID: 214148) used administrative claims data from the Optum Research Database. Eligible patients were ≥ 6 years of age with asthma and had ≥ 2 mepolizumab claims post-index. Index date was the first mepolizumab claim/administration (January 2016–December 2018). Patients were divided into two cohorts: allergic and non-allergic asthma, based on diagnosis codes, medication use and lab test results. Outcomes included the rate of asthma-related exacerbations and oral corticosteroid (OCS) use during the 12 months before (baseline period) and 12 months after (follow-up period) mepolizumab initiation. Study ended in December 2019. Results: Overall, 240 (44.6%) and 298 (55.4%) patients were included in the allergic and non-allergic asthma cohorts, respectively. Mean (standard deviation [SD]) counts of asthma-related exacerbations were significantly reduced from baseline to follow-up in both the allergic and non-allergic asthma cohorts (3.2 [2.5] to 2.1 [2.1], p < 0.001 and 2.5 [2.2] to 1.7 [1.9], p < 0.001, respectively). The mean number of OCS pharmacy claims was significantly decreased by 33.3% and 41.4% from baseline to follow-up in the allergic and non-allergic cohorts, respectively (p < 0.001); mean daily OCS dose significantly decreased by 30.6% and 45.4%, respectively (p < 0.001) as well as the mean number of OCS bursts, which decreased by 44.9% and 41.8%, respectively (p < 0.001). No significant differences were observed between cohorts in reductions in asthma exacerbations, counts of OCS pharmacy claims or OCS bursts (baseline to follow-up). Conclusion: Mepolizumab significantly reduced asthma exacerbations and OCS use in patients with allergic and non-allergic asthma, suggesting that mepolizumab provides real-world benefit in severe asthma irrespective of whether a patient has an allergic phenotype.

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