Attitudes and Practices Regarding Dosing Interval Extension of Biologics in Severe Asthma: A Nationwide Survey and Real-World Data From the Dutch RAPSODI Registry.
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Marijnissen Camiel J M, Sont Jacob K, Meulmeester Fleur L, Wouters Michel W J M, Braunstahl Gert-Jan, Aldenkamp Arnoud F, Hashimoto Simone, Kroes Johannes A, van den Akker-van Marle M Elske, Steyerberg Ewout W, van Bodegom-Vos Leti, van Bezouw Maarten J, Hilvering Bart, Weersink Els J M, van der Sar-van der Brugge Simone, Fieten Karin B, Beukert Annelies, Retera Jeroen M A M, Oud Karen T M, van der Meer Renske, Patberg Kornelis W, Macken Thomas, de Visser Veerle L, Conemans Lennart H, van Velzen Edwin, van Veen Ilonka H, van Huisstede Astrid, Romme Elisabeth A P M, Amelink Marijke, van Ruitenbeek Charlotte A, Ten Brinke Anneke, Kappen Jasper H
Аннотация
OBJECTIVE: To explore physician attitudes and real-world practices regarding dosing interval extensions for biologics in severe asthma.
METHODS: We assessed attitudes to dosing interval extension among Dutch pulmonologists prescribing biologics through a 28-item nationwide e-survey and investigated clinical practices using data from the Dutch severe asthma registry RAPSODI (Dutch Registry of Adult Patients with Severe asthma for Optimal DIsease management).
RESULTS: Of 50 pulmonologists, 39 (78%) reported extending dosing intervals, primarily due to good clinical response (95%) and treatment costs (77%). Most required at least 1 year of stable asthma (82%), which respondents defined as 6-item Asthma Control Questionnaire score less than 1.5, stable lung function, absence of exacerbations, and no maintenance oral corticosteroids. Reported success rates exceeded 50% for 62% of respondents, with failures mainly due to exacerbations or worsening symptoms. Interval extension was more frequent among physicians treating more than 25 patients with severe asthma (P < .01). Major barriers included lack of evidence (63%) and experience (52%), yet 91% expressed a wish to extend intervals more often. In RAPSODI (n = 1603), 159 interval extensions were recorded in 138 patients across 14 hospitals. Median increase in interval relative to the standard interval was 50% (range, 12.5%-300%) with multiple sequential extensions in 14% of patients. In 2024, the annual incidence of extensions was 5.2%, and the prevalence was 11.4%.
CONCLUSIONS: A vast majority of Dutch pulmonologists already apply dosing interval extension of biologics in severe asthma, however on a limited scale. Although the frequency is increasing, clinicians are reluctant to apply extension broadly due to limited experience and evidence, highlighting the need for evidence-based guidelines.