Reducing barriers to biologic access may help more people with severe asthma achieve remission

Ecological analysis links easier access to biologic therapies with better asthma outcomes, including clinical remission

Building on the GLEAM I study linking earlier identification and treatment of high-risk and severe asthma with greater likelihood of remission, the GLEAM II study reveals that patients in countries with fewer barriers to biologic access were significantly more likely to achieve clinical remission and other favourable asthma outcomes than those in countries with more restrictive access policies. Published in The Journal of Asthma and Allergy and titled “Association of easier biologic access with remission and other clinical outcomes in severe asthma: a global real-world study”, the findings indicate that improving access to biologic therapies may contribute to making earlier treatment a reality.

The study analysed data from 9,183 adults with severe asthma across 21 countries, using information from three of the world's largest severe asthma datasets: the International Severe Asthma Registry (ISAR), the US CHRONICLE registry and the UK Optimum Patient Care Research Database (OPCRD). Rather than examining when individual patients started biologics, the paper investigated whether healthcare systems that impact ease of access to biologics affect patient outcomes overall.

To assess this, researchers used the Biologic Accessibility Score (BACS), a validated measure that reflects how restrictive national prescribing criteria are for biologic therapies. Countries with higher scores have broader eligibility criteria and fewer prescribing barriers, making biologics more readily available to appropriate patients.¹

Key findings

Across the participating countries, easier biologic access was linked with better outcomes one year after treatment initiation.

Patients treated in healthcare systems with greater biologic accessibility were more likely to:

• Achieve clinical remission (where patients experience no severe asthma attacks, no need for long-term oral corticosteroids, have well-controlled asthma, and stable lung function)

• Experience no severe asthma exacerbations (attacks)

• Have well- or partly controlled asthma

• Achieve normal or near-normal lung function

• Discontinue long-term oral corticosteroid treatment

Figure: Higher BACS associated with a higher probability of achieving remission. LTOCS: Long-term Oral Corticosteroid, Clinical remission: 2-domain = no severe exacerbations + no long-term oral corticosteroid use; 3-domain = 2-domain + asthma control or preserved lung function; 4-domain = all four domains (exacerbations, oral corticosteroid use, asthma control and lung function). Points represent individual countries with size of the circle indicating precision of the result for that country.

The strongest associations were observed for clinical remission, with easier biologic access strongly linked with higher proportions of patients achieving remission across multiple recognised definitions.

Improving access to biologics may be critical to enabling earlier intervention for eligible patients and helping more people achieve the full benefits of treatment.

Professor David Price, founder of ISAR and OPCRD and a lead author of the study, commented “This study underscores an important opportunity for change: in facilitating healthcare systems with fewer prescribing restrictions, biologic treatment may be commenced before years of uncontrolled disease, repeated exacerbations and cumulative oral corticosteroid exposure that reduce the likelihood of achieving the best outcomes for patients”.

Although biologic therapies have transformed the treatment of severe asthma, access remains highly variable around the world because of differences in reimbursement policies, eligibility criteria and healthcare pathways. The authors of the study conclude that through improving equitable access to biologics, by forming streamlined referral pathways, broadening reimbursement criteria and reducing administrative barriers, more patients may receive treatment at the optimal stage and unlock the greatest therapeutic potential.

To learn more about the study, please read the full publication in The Journal of J Asthma and Allergy, as well as the accompanying slide deck.

Acknowledgement: ISAR is operated by Optimum Patient Care Global (OPCG) and co-funded by OPCG and AstraZeneca Ltd. We thank all investigators, collaborators, and patients who contributed to this research.

About OPRI   

The Observational and Pragmatic Research Institute (OPRI) is an internationally recognized independent research organization dedicated to providing real-world evidence that supports best practices in chronic disease management in primary care. Learn more at https://www.opri.org.uk/. For media inquiries and additional information, please contact https://www.opri.org.uk/contact.  

About ISAR 

The International Severe Asthma Registry (ISAR) is the first global adult severe asthma registry, providing a rich, standardized dataset to advance research, clinical practice, and policy in severe asthma care. It fosters international collaboration to improve outcomes for patients worldwide. ISAR is operated by Optimum Patient Care Global Ltd. (OPCG) and co-funded by OPCG and AstraZeneca. Learn more at https://www.isar.opcglobal.org. 

1.      Porsbjerg C et al. Global variability in administrative approval prescription criteria for biologic therapy in severe asthma. J Asthma Allergy 2022;10(5):P1202-1216.