ALERT (ChAracterizing uncontroLled sevERe asThma in Canada): oral corticosteroid and short-acting β2-agonist overuse.

Abstract

Background: Approximately 230,000-465,000 patients in Canada have severe asthma; of these, 4-31% are uncontrolled. Despite increased availability of biologics, many rely on oral corticosteroids (OCS) or short-acting β2-agonists (SABA), which are associated with substantial short- and long-term adverse effects.

Objective: ALERT aimed to characterize the demographics of patients with severe asthma and uncontrolled severe asthma with and/or without biologics in Canada and describe OCS/SABA and biologic treatment patterns.

Methods: ALERT was a retrospective descriptive study using longitudinal claims data from IQVIA's private drug plan database and the Ontario drug benefits database. Adult patients with an inferred asthma diagnosis were assessed and selected using a rule-based inference algorithm and further classified as having severe asthma, uncontrolled severe asthma and uncontrolled severe asthma without biologics, based on eligibility criteria including inhaled therapies and OCS use. Patients were assessed for OCS, SABA and biologic use in the 12-month analysis period; regional variation was described.

Results: Patients with severe asthma, uncontrolled severe asthma and uncontrolled severe asthma without biologics had a mean of 2.7, 4.4 and 4.2 OCS claims per patient/year, respectively. Of patients with uncontrolled severe asthma, 8.3% had ≥10 OCS claims. Combined OCS/SABA overuse (≥2 OCS/≥3 SABA claims in the study period) was recorded in 6.1% of patients with severe asthma. Most patients with uncontrolled severe asthma (71.8%) had no biologic claims. Regional disparities in OCS use were observed.

Conclusion: Optimization of asthma management through improved diagnosis, patient education, earlier specialist referral and region-specific improvements is needed to reduce OCS/SABA use and increase biologic uptake for eligible patients.