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Abstract
Background
Omalizumab (Xolair) is licensed for the treatment of severe allergic asthma patients with IgE mediated disease.
Within the UK NICE guidance includes criteria for documented adherence to Inhaled Corticosteroids (ICS) and other asthma related medications.
Within the UK there is no clear definition of ‘documented compliance’ Within the Severe Asthma North West MDT this is defined as a≥80% collection of ICS based on GP data.
Objective To assess adherence to ICS treatment for patients on Omalizumab therapy and to explore causal relationships and outcomes between the adherent and non-adherent groups.
Methods Over a 2 week period in Feb 2017 patients attending for routine Omalizumab care (post 16 week assessment) underwent standard observations (FEV1, FeNO and ACQ-7) additionally each patient was asked to clarify the type and frequency of current ICS and adherence data was obtained from the patients GP for the last 6 months.
Results Of 79 patients (67.1%) were female and (32.9%) were male, with a mean age of 50.7 (SD 14.12). ICS adherence was observed in 39 (49.4%) of patients. Comparison between the two groups (Table 1), demonstrates little difference between both groups. The adherent group have a lower baseline FEV1 (55%) and FeNO (15.5 ppb) compared to the non-adherent group (61.9% and 22.0 ppb), and demonstrate a higher percentage change in FEV1 from baseline (8.3% compared to 5.67%). Both groups demonstrate a significant improvement in ACQ-7 from baseline, and there was a trend (p=0.067) for better control (lower ACQ-7 score) in the non-adherent group.
Conclusion
Non adherence to ICS in patients on Omalizumab therapy is a significant issue.
There were no significant differences between the 2 groups in terms of exacerbations or ICS treatment regimes.
There was a statistical, but not clinically significant rise in FeNO in the non-adherent group.
There was a trend towards better perceived asthma control as measured by the ACQ-7 in the non-adherent group which may influence ongoing adherence to ICS.
Reference
Asthma Control Questionnaire. https://www.qoltech.co.uk/acq.html