Duration and determinants of biologic initiation in the treatment of severe asthma

Background

Factors influencing biologic initiation in severe asthma remain unclear.

Methods

We retrospectively evaluated the duration and determinants of biologic initiation in 54 patients with severe asthma who were started on biologics at our hospital between 2018 and 2024.

Results

The median age was 74 years, and 72.2 % of the patients were biologic-naïve. Patients required a median of three explanations for biologic initiation, with 25.9 % requiring four or more. These patients had a higher prevalence of pre-prescribed oral corticosteroids (OCS) for anticipated exacerbations (58.3 % vs. 7.1 %, P < 0.001) and more frequent exacerbations (median, 4 vs. 1; P = 0.004). Multivariate analysis identified pre-prescribed OCS as an independent factor requiring four or more explanations (adjusted odds ratio, 10.50; P = 0.008). Exacerbation was the primary determinant of initiation (64.8 %).

Conclusions

Pre-prescribed OCS and frequent exacerbations contributed to delays in biologic initiation. To facilitate timely initiation, habitual pre-prescribed OCS use without an action plan should be avoided.