Biologic Injection-Related Pain in Severe Asthma, Its Impact on Treatment Aversion, and Pain-Relief Approach: A Multicenter Observational Study.

Abstract

Background: Although biologic therapies are essential for managing severe asthma, injection-related pain may be a frequently overlooked barrier to treatment persistence.

Objective: To quantify biologic injection-related pain in asthma cases, identify clinical factors associated with such pain and treatment aversion, and explore practical pain-relief approaches.

Methods: This multicenter observational study enrolled patients with asthma receiving biologics between May 2025 and March 2026. Insertion pain, injection pain, and treatment aversion attributable to injection-related pain were assessed using 0 to 10 visual analog scales. Associations between clinical factors, pain scores, and treatment aversion scores and the effects of local pressure and cooling at the injection site were evaluated. Patients with diabetes mellitus receiving tirzepatide served as a reference group.

Results: In total, 122 biologic-treated and 27 tirzepatide-treated patient responses were analyzed. Mean insertion and injection pain scores for biologics were 3.00 ± 2.60 and 3.28 ± 2.91, respectively. Adjusted pain scores did not differ significantly across biologics and tirzepatide. Insertion pain was associated with anxiety and arm injection, whereas injection pain was associated with younger age and female sex. Both insertion and injection pain showed independent associations with log-transformed treatment aversion score (unstandardized regression coefficient [B] = 0.08, 95% CI, 0.03-0.12, and B = 0.07, 95% CI, 0.03-0.11, respectively). Injection-site cooling significantly reduced both pain types.

Conclusions: Among patients receiving biologics for asthma, injection-related pain is common and independently associated with treatment aversion. Local cooling may offer a simple approach to reducing injection-related pain and addressing treatment aversion.