Pre-biologic assessment of adherence in severe asthma and association with biologic continuation – a UK Severe Asthma Registry Study

Freda Yang; Ronald McDowell; John Busby; Anna Murphy; Pujan Patel; David Jackson; Adel H Mansur; Paul Pfeffer; Thomas Pantin; Robin Gore; Thomas Brown; Shamsa Naveed; Hassan Burhan; Mitesh Patel; Elfatih Idris; Ian D Pavord; Deepak Subramanian; James Dodd; Hitasha Rupani; Rekha Chaudhuri; Aashish Vyas; Shoaib Faruqi; David Sammut; Simon Message; Matthew Masoli; Chloe Bloom; Liam  Heaney; Salman Siddiqui

doi:10.1136/bmjresp-2024-003019

Pre-biologic assessment of adherence in severe asthma and association with biologic continuation – a UK Severe Asthma Registry Study

Freda Yang
, Ronald McDowell
, John Busby
, Anna Murphy
, Pujan Patel
, David Jackson
, Adel H Mansur
, Paul Pfeffer
, Thomas Pantin
, Robin Gore
, Thomas Brown
, Shamsa Naveed
, Hassan Burhan
, Mitesh Patel
, Elfatih Idris
, Ian D Pavord
, Deepak Subramanian
, James Dodd
, Hitasha Rupani
, Rekha Chaudhuri

Aashish Vyas, Shoaib Faruqi, David Sammut, Simon Message, Matthew Masoli, Chloe Bloom, Liam Heaney, Salman Siddiqui

Research output: Contribution to journal › Article › peer-review

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Abstract

Background 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.

Methods 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.

Results 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).

Conclusion 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.

Original language	English
Article number	e003019
Pages (from-to)	1-9
Number of pages	9
Journal	BMJ Open Respiratory Research
Volume	12
Issue number	1
Early online date	24 Jun 2025
DOIs	https://doi.org/10.1136/bmjresp-2024-003019
Publication status	Published (in print/issue) - 24 Jun 2025

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2025.

Data Availability Statement

Data are available upon reasonable request.

Funding

The UK Severe Asthma Registry (UKSAR) is funded by the National Health Service Regional Severe Asthma Networks in the UK. This post-hoc analysis received support from the NIHR Imperial Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Funders
AstraZeneca
Novartis
Sanofi
Liverpool School of Tropical Medicine
NIHR
GlaxoSmithKline

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Severe asthma
Adherence
Medication possession ratio
Biologics
Biologic response
Omalizumab
Mepolizumab
Reslizumab
benralizumab
dupilumab
anti-IgE
anti-IL4
anti-IL5
anti-IL5R
UKSAR
severe asthma registry
Humans
Adrenal Cortex Hormones
Middle Aged
Male
Hydrocortisone
Registries
Adult
Female
Prednisolone
Fractional Exhaled Nitric Oxide Testing
Severity of Illness Index
Asthma Guidelines
Anti-Asthmatic Agents
Administration, Inhalation
United Kingdom
Nitric Oxide
Asthma
Asthma Epidemiology
Aged
Hydrocortisone/blood
Anti-Asthmatic Agents/therapeutic use
Asthma/drug therapy
United Kingdom/epidemiology
Prednisolone/blood
Adrenal Cortex Hormones/administration & dosage

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10.1136/bmjresp-2024-003019Licence: CC BY-NC

e003019.fullFinal published version, 934 KBLicence: CC BY-NC

Cite this

Yang, F., McDowell, R., Busby, J., Murphy, A., Patel, P., Jackson, D., Mansur, A. H., Pfeffer, P., Pantin, T., Gore, R., Brown, T., Naveed, S., Burhan, H., Patel, M., Idris, E., Pavord, I. D., Subramanian, D., Dodd, J., Rupani, H., ... Siddiqui, S. (2025). Pre-biologic assessment of adherence in severe asthma and association with biologic continuation – a UK Severe Asthma Registry Study. BMJ Open Respiratory Research, 12(1), 1-9. Article e003019. https://doi.org/10.1136/bmjresp-2024-003019

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title = "Pre-biologic assessment of adherence in severe asthma and association with biologic continuation – a UK Severe Asthma Registry Study",

abstract = "Background 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. Methods 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. Results 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). Conclusion 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.",

keywords = "Severe asthma, Adherence, Medication possession ratio, Biologics, Biologic response, Omalizumab, Mepolizumab, Reslizumab, benralizumab, dupilumab, anti-IgE, anti-IL4, anti-IL5, anti-IL5R, UKSAR, severe asthma registry, Humans, Adrenal Cortex Hormones, Middle Aged, Male, Hydrocortisone, Registries, Adult, Female, Prednisolone, Fractional Exhaled Nitric Oxide Testing, Severity of Illness Index, Asthma Guidelines, Anti-Asthmatic Agents, Administration, Inhalation, United Kingdom, Nitric Oxide, Asthma, Asthma Epidemiology, Aged, Hydrocortisone/blood, Anti-Asthmatic Agents/therapeutic use, Asthma/drug therapy, United Kingdom/epidemiology, Prednisolone/blood, Adrenal Cortex Hormones/administration \& dosage",

author = "Freda Yang and Ronald McDowell and John Busby and Anna Murphy and Pujan Patel and David Jackson and Mansur, \{Adel H\} and Paul Pfeffer and Thomas Pantin and Robin Gore and Thomas Brown and Shamsa Naveed and Hassan Burhan and Mitesh Patel and Elfatih Idris and Pavord, \{Ian D\} and Deepak Subramanian and James Dodd and Hitasha Rupani and Rekha Chaudhuri and Aashish Vyas and Shoaib Faruqi and David Sammut and Simon Message and Matthew Masoli and Chloe Bloom and Liam Heaney and Salman Siddiqui",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2025.",

year = "2025",

month = jun,

day = "24",

doi = "10.1136/bmjresp-2024-003019",

language = "English",

volume = "12",

pages = "1--9",

journal = "BMJ Open Respiratory Research",

issn = "2052-4439",

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number = "1",

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Yang, F, McDowell, R, Busby, J, Murphy, A, Patel, P, Jackson, D, Mansur, AH, Pfeffer, P, Pantin, T, Gore, R, Brown, T, Naveed, S, Burhan, H, Patel, M, Idris, E, Pavord, ID, Subramanian, D, Dodd, J, Rupani, H, Chaudhuri, R, Vyas, A, Faruqi, S, Sammut, D, Message, S, Masoli, M, Bloom, C, Heaney, L & Siddiqui, S 2025, 'Pre-biologic assessment of adherence in severe asthma and association with biologic continuation – a UK Severe Asthma Registry Study', BMJ Open Respiratory Research, vol. 12, no. 1, e003019, pp. 1-9. https://doi.org/10.1136/bmjresp-2024-003019

TY - JOUR

T1 - Pre-biologic assessment of adherence in severe asthma and association with biologic continuation – a UK Severe Asthma Registry Study

AU - Yang, Freda

AU - McDowell, Ronald

AU - Busby, John

AU - Murphy, Anna

AU - Patel, Pujan

AU - Jackson, David

AU - Mansur, Adel H

AU - Pfeffer, Paul

AU - Pantin, Thomas

AU - Gore, Robin

AU - Brown, Thomas

AU - Naveed, Shamsa

AU - Burhan, Hassan

AU - Patel, Mitesh

AU - Idris, Elfatih

AU - Pavord, Ian D

AU - Subramanian, Deepak

AU - Dodd, James

AU - Rupani, Hitasha

AU - Chaudhuri, Rekha

AU - Vyas, Aashish

AU - Faruqi, Shoaib

AU - Sammut, David

AU - Message, Simon

AU - Masoli, Matthew

AU - Bloom, Chloe

AU - Heaney, Liam

AU - Siddiqui, Salman

N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2025.

PY - 2025/6/24

Y1 - 2025/6/24

N2 - Background 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. Methods 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. Results 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). Conclusion 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.

AB - Background 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. Methods 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. Results 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). Conclusion 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.

KW - Severe asthma

KW - Adherence

KW - Medication possession ratio

KW - Biologics

KW - Biologic response

KW - Omalizumab

KW - Mepolizumab

KW - Reslizumab

KW - benralizumab

KW - dupilumab

KW - anti-IgE

KW - anti-IL4

KW - anti-IL5

KW - anti-IL5R

KW - UKSAR

KW - severe asthma registry

KW - Humans

KW - Adrenal Cortex Hormones

KW - Middle Aged

KW - Male

KW - Hydrocortisone

KW - Registries

KW - Adult

KW - Female

KW - Prednisolone

KW - Fractional Exhaled Nitric Oxide Testing

KW - Severity of Illness Index

KW - Asthma Guidelines

KW - Anti-Asthmatic Agents

KW - Administration, Inhalation

KW - United Kingdom

KW - Nitric Oxide

KW - Asthma

KW - Asthma Epidemiology

KW - Aged

KW - Hydrocortisone/blood

KW - Anti-Asthmatic Agents/therapeutic use

KW - Asthma/drug therapy

KW - United Kingdom/epidemiology

KW - Prednisolone/blood

KW - Adrenal Cortex Hormones/administration & dosage

UR - https://www.scopus.com/pages/publications/105009370114

U2 - 10.1136/bmjresp-2024-003019

DO - 10.1136/bmjresp-2024-003019

M3 - Article

C2 - 40555553

SN - 2052-4439

VL - 12

SP - 1

EP - 9

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

IS - 1

M1 - e003019

ER -

Pre-biologic assessment of adherence in severe asthma and association with biologic continuation – a UK Severe Asthma Registry Study

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Keywords

Access to Document

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