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A2811 - Allergy Tests in Patients with Severe Asthma
Author Block: H. Cao1, B. Ortiz1, E. Stanek1, Q. Huang2, L. Wang2, D. Wertz2, A. Kavati1; 1Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States, 2HealthCore, Inc., Wilmington, DE, United States.
Introduction: The Global Initiative for Asthma (GINA) guidelines recommend referring patients inadequately controlled on step 4 medications for add-on treatments such as anti-IgE.1 Serum IgE testing could be used to confirm allergic asthma diagnosis and aid the selection of anti-IgE. Limited studies have examined the use of serum IgE testing for uncontrolled severe asthma (SA) patients. Methods: We conducted a retrospective cohort study using the HealthCore Integrated Research Database, an administrative claims database for a large commercially insured population in the US. The study used Healthcare Effectiveness Data and Information Set criteria2 to identify persistent asthma patients (≥6 years old) and then used patients’ medications as a proxy to identify SA patients on GINA step 4/5 treatments in 2014 and 2015. Patients were identified as prevalent if they had asthma diagnosis or asthma medications in the prior year, or as incident if they did not. For prevalent patients, the index was January 1st of the year. For incident patients, the index was the date of their first GINA step 4/5 treatment. Patient characteristics were summarized descriptively for each year. We examined the percentage of uncontrolled SA patients. A patient was identified as uncontrolled if he/she had ≥1 moderate/severe exacerbation(s) during the 12-month follow-up period. We investigated the utilization of allergy tests including serum allergy tests among SA patients and the uncontrolled subgroup. Results: The study identified 22,152 prevalent and 7,961 incident SA patients in 2014, and 30,035 prevalent and 5,889 incident patients in 2015. The mean age was 46.3 in 2014 and 46.4 in 2015 for prevalent patients, and 43.7 in 2014 and 44.5 in 2015 for incident patients. 19.6% of SA patients were uncontrolled in both years. The mean annual rate of exacerbations among the uncontrolled patients was 1.4. In the uncontrolled subgroup, 79.2% of patients in 2014 and 79.7% in 2015 did not have any type of allergy tests. Among the most severe group - step 4 patients with ≥1 asthma-related hospitalization(s) and step 5 patients who could be considered for anti-IgE treatments, only 21.5% in 2014 and 22.3% in 2015 were tested for serum IgE. Conclusion: Allergy tests are under-utilized in SA patients. Among uncontrolled severe asthma patients who could be considered for anti-IgE treatment, IgE tests are not widely used. References: 1. Global Strategy for Asthma Management and Prevention. 2015; Available from: http://ginasthma.org/. 2. Use of Appropriate Medications for People With Asthma. 2015; https://www.ncqa.org/Portals/0/PublicComment/HEDIS2016/11.%20Use%20of%20Appropriate%20Medications%20for%20People%20with%20Asthma.pdf