Molly M Jeffery1, Nilay D Shah1, Pinar Karaca-Mandic2, Joseph S Ross3, Matthew A Rank4. 1. Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn. 2. Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minn. 3. Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn; Department of Health Policy and Management, Yale University School of Public Health, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Conn. 4. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz. Electronic address: rank.matthew@mayo.edu.
Abstract
BACKGROUND: Utilization trends of omalizumab, a first-in-its-class asthma biologic approved in 2003 for individuals not controlled by inhaled corticosteroids (ICSs), may reveal lessons in patient selection. OBJECTIVE: To describe utilization patterns for omalizumab since its introduction in 2003, with a focus on patient-level characteristics of patients for whom omalizumab was initiated. METHODS: Using a large US database of administrative claims, we identified privately insured and Medicare Advantage beneficiaries with asthma between 2003 and 2015. Characteristics of incident (no omalizumab use in the previous 12 months) and prevalent users of omalizumab for asthma were described and omalizumab use trends graphed. A comparison cohort (1:5 matching proportion) of nonomalizumab users was compared with incident omalizumab users on demographic characteristics, medication adherence (medication possession ratio [MPR]) for ICSs and/or ICS/long-acting β-agonist (ICS-LABA), exacerbation frequency, and asthma control in the 6 months before omalizumab initiation. RESULTS: We identified 7,658 prevalent and 3,399 incident omalizumab users. Omalizumab incidence peaked in the second quarter of 2004 at 0.65 per 1,000 individuals with asthma, whereas prevalence peaked in the fourth quarter of 2006 at 3.22; as of fourth quarter 2015, rates were 0.14 and 1.96, respectively. In the 12 months before omalizumab initiation, 72.5% had low adherence (MPR ≤ 0.75) and 48.6% had very low adherence (MPR ≤ 0.5) to ICSs and/or ICS-LABA. In the period 2003 to 2015, the mean number of exacerbations in the 12 months before incident use ranged from 1.50 to 2.11 and the proportion that had poor asthma control (≥3 rescue inhalers dispensed) ranged from 54% to 67%. Incident omalizumab users were less likely to have good asthma control than the matched cohort of nonusers (adjusted odds ratio, 0.53 [0.48-0.59]). CONCLUSIONS: Omalizumab use for asthma has been gradually decreasing following a peak shortly after its market availability. Many omalizumab users have low or very low adherence rates for ICSs and/or ICS-LABA in the 12 months before omalizumab initiation.
BACKGROUND: Utilization trends of omalizumab, a first-in-its-class asthma biologic approved in 2003 for individuals not controlled by inhaled corticosteroids (ICSs), may reveal lessons in patient selection. OBJECTIVE: To describe utilization patterns for omalizumab since its introduction in 2003, with a focus on patient-level characteristics of patients for whom omalizumab was initiated. METHODS: Using a large US database of administrative claims, we identified privately insured and Medicare Advantage beneficiaries with asthma between 2003 and 2015. Characteristics of incident (no omalizumab use in the previous 12 months) and prevalent users of omalizumab for asthma were described and omalizumab use trends graphed. A comparison cohort (1:5 matching proportion) of nonomalizumab users was compared with incident omalizumab users on demographic characteristics, medication adherence (medication possession ratio [MPR]) for ICSs and/or ICS/long-acting β-agonist (ICS-LABA), exacerbation frequency, and asthma control in the 6 months before omalizumab initiation. RESULTS: We identified 7,658 prevalent and 3,399 incident omalizumab users. Omalizumab incidence peaked in the second quarter of 2004 at 0.65 per 1,000 individuals with asthma, whereas prevalence peaked in the fourth quarter of 2006 at 3.22; as of fourth quarter 2015, rates were 0.14 and 1.96, respectively. In the 12 months before omalizumab initiation, 72.5% had low adherence (MPR ≤ 0.75) and 48.6% had very low adherence (MPR ≤ 0.5) to ICSs and/or ICS-LABA. In the period 2003 to 2015, the mean number of exacerbations in the 12 months before incident use ranged from 1.50 to 2.11 and the proportion that had poor asthma control (≥3 rescue inhalers dispensed) ranged from 54% to 67%. Incident omalizumab users were less likely to have good asthma control than the matched cohort of nonusers (adjusted odds ratio, 0.53 [0.48-0.59]). CONCLUSIONS:Omalizumab use for asthma has been gradually decreasing following a peak shortly after its market availability. Many omalizumab users have low or very low adherence rates for ICSs and/or ICS-LABA in the 12 months before omalizumab initiation.
Authors: Jacob T Maddux; Jonathan W Inselman; Molly M Jeffery; Regina W Lam; Nilay D Shah; Matthew A Rank Journal: Chest Date: 2020-10-24 Impact factor: 9.410
Authors: Molly M Jeffery; Jonathan W Inselman; Jacob T Maddux; Regina W Lam; Nilay D Shah; Matthew A Rank Journal: J Allergy Clin Immunol Pract Date: 2021-02-27
Authors: Giorgio Walter Canonica; Giorgio Lorenzo Colombo; Giacomo Matteo Bruno; Sergio Di Matteo; Chiara Martinotti; Francesco Blasi; Caterina Bucca; Nunzio Crimi; Pierluigi Paggiaro; Girolamo Pelaia; Giovanni Passalaqua; Gianenrico Senna; Enrico Heffler Journal: World Allergy Organ J Date: 2019-01-26 Impact factor: 4.084
Authors: Marco Caminati; Andrea Vianello; Margherita Andretta; Anna Michela Menti; Silvia Tognella; Luca Degli Esposti; Claudio Micheletto; Chiara Bovo; Gianenrico Senna Journal: ERJ Open Res Date: 2020-04-27
Authors: Alison Moore; Andrew Preece; Raj Sharma; Liam G Heaney; Richard W Costello; Robert A Wise; Andrea Ludwig-Sengpiel; Giselle Mosnaim; Jamie Rees; Ryan Tomlinson; Ruth Tal-Singer; David A Stempel; Neil Barnes Journal: Eur Respir J Date: 2021-06-04 Impact factor: 33.795