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Prevalence of patients with uncontrolled asthma despite high intensity treatment (NVL/GINA step 4/5) in Germany
Background Despite the licensing of biologicals in recent years, surveys show that in real life patients with severe asthma remain who are not exposed to these treatments despite of inadequately controlled asthma. The aim of the current study was to characterize and estimate patients with NVL/GINA level 4 or 5 asthma and signs of poor control in Germany in order to approximate the level of undertreatment.
Methods In 2021 we analyzed data collected during 2019 (before the start of the COVID-19 pandemic) using the IQVIA™ LRx and IQVIA™ Disease Analyzer databases. IQVIA™ LRx contains anonymized longitudinal data covering approximately 80% of statutory health insurance (GKV) prescriptions in Germany with most relevant information about prescriptions including prescribed products, substances, packs (Pharmazentralnummer PZN), prescription date and prescriber specialty, basic patient demographics or location of the prescriber on a KV district level. The IQVIA™ Disease Analyzer is a database of anonymized electronic medical records from a representative sample of office-based GPs and specialists in Germany. An Expert committee of pulmonologists from different hospitals and expert practices supported the study. Asthma patients treated according to NVL/GINA 4/5 and frequently using SABAs (≥ 3 on days with no ICS-containing prescriptions/year) and/or OCS prescriptions (score of ≥ 2/year, a pulmonologist prescription scored 1, GP 0.75) were classified as severe, uncontrolled asthma.
Results In 2019, 3.4 million patients in Germany received at least two prescriptions of medications licensed for asthma and 2.4 million patients had an asthma diagnosis and received asthma maintenance therapy. 625,000 asthma patients were treated according to NVL/GINA 4 or 5. Among these 54,000 patients were uncontrolled according to the pre-defined OCS and/or SABA use, which corresponds to approximately 15% of all patients in certain regions (Figure).
Conclusion In 2019 approximately 54,000 patients in Germany who were being treated according to NVL/GINA 4/5 had evidence suggesting poor asthma control, accounting for up to 15% of the asthma population in some regions of Germany. Yet, only about 12,000 patients were being treated with biologicals suggesting a possible treatment gap that requires further investigation.
Article published online:
11 May 2022
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