Clinical and Healthcare Cost Characteristics of Severe Asthma Patients with Long-Term Control on Omalizumab: A Comparative Analysis with Patients Who Switched to Other Biologics.

Background and purpose: Biologics are crucial for severe asthma treatment, but their high costs pose challenges. Omalizumab (OML) is dosed on the basis of patient-specific factors. The purpose of this study is to clarify the clinical characteristics of severe asthmatics who maintain long-term control on omalizumab including healthcare cost considerations.

Patients and methods: A retrospective, multicenter cohort study was conducted. Patients receiving OML at three institutions were enrolled. Patients continuing OML (C-OML) were compared with those switching to other biologics (S-OML) in terms of clinical background, cost-effectiveness, and type-2 inflammation levels.

Results: Forty-seven patients were enrolled. The C-OML group achieved exacerbation control comparable to that of the S-OML group, with a median OML dose of 300 mg/month, resulting in significantly lower personal payments (p < 0.01). Compared with the S-OML group, the C-OML group had a greater prevalence of overweight (p = 0.04), a lower prevalence of eosinophilic chronic rhinosinusitis (p < 0.01), and a trend toward a higher prevalence of allergic rhinitis (p = 0.06). Effective asthma control with OML was associated with nonsevere type-2 inflammation (eosinophils < 300/μL and FeNO < 50 ppb).

Conclusion: Patients with nonsevere type-2 inflammation and a high BMI can achieve effective asthma control with OML, reducing treatment costs. Identifying this phenotype can improve the cost-effectiveness of biologic therapies for patients with severe asthma.