Prevalence of Patients with Uncontrolled Asthma Despite NVL/GINA Step 4/5 Treatment in Germany

Abstract

Karl-Christian Bergmann,1 Dirk Skowasch,2 Hartmut Timmermann,3 Robert Lindner,4 Johann Christian Virchow,5 Olaf Schmidt,6 Dirk Koschel,7 Claus Neurohr,8 Sebastian Heck,9 Katrin Milger10 1Institute for Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany; 2Department of Internal Medicine II – Pneumology, University Hospital Bonn, Bonn, Germany; 3Schwerpunktpraxis Colonnaden, Hamburg, Germany; 4IQVIA Commercial GmbH & Co. OHG, Frankfurt Am Main, Germany; 5Universitätsmedizin Rostock - Zentrum für Innere Medizin, Medizinische Klinik I, Abteilung Pneumologie & Interdisziplinäre Internistische Intensivmedizin, Rostock, Germany; 6Pneumologische Gemeinschaftspraxis und Studienzentrum KPPK, Koblenz, Germany; 7Fachkrankenhaus Coswig, Lung Centre, Coswig, and Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany; 8Abteilung für Pneumologie und Beatmungsmedizin, Robert-Bosch-Krankenhaus Lungenzentrum, Stuttgart, Germany; 9GlaxoSmithKline GmbH & Co. KG, Munich, Germany; 10Department of Medicine V, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, GermanyCorrespondence: Karl-Christian Bergmann, Institute for Allergology-Charité, Luisenstraße 2, Berlin, 10117, Germany, Tel [phone], Fax [phone], Email [email protected]: Asthma is one of the most prevalent chronic diseases in Germany affecting 4– 5% of all adults and 10% of children. Despite the availability of biologicals in recent years, studies show patients with inadequately controlled severe asthma in real life. The aim of the current study was to characterize and estimate the number of patients with NVL/GINA level 4 or 5 asthma and signs of poor control in Germany.Patients and Methods: In 2021, we retrospectively analyzed data collected during 2019 using the IQVIA™ LRx and IQVIA™ Disease Analyzer databases which contain anonymized longitudinal data covering approximately 80% of statutory health insurance (GKV) prescriptions in Germany with most relevant information about prescriptions, basic patient demographics or location of the prescriber; the IQVIA™ Disease Analyzer anonymized electronic medical records from a representative sample of office-based GPs and specialists. An expert committee of pulmonologists from different hospitals and expert practices supported the study. Asthma patients treated according to NVL/GINA 4/5 who used SABAs frequently (≥ 3 on days with no ICS-containing prescriptions/year) and/or received prescriptions for oral corticosteroids (OCS) (score of ≥ 2/year, a pulmonologist prescription scored 1.0, GP 0.75) were classified as severe, uncontrolled asthma.Results: In 2019, 3.4 million patients received at least two prescriptions of respiratory medications and 2.4 million patients on maintenance respiratory treatment have asthma. A total of 625,000 asthma patients were treated according to NVL/GINA step 4 or 5. Among these, 54,000 were uncontrolled according to the pre-defined OCS and/or SABA use, which corresponds to approximately 15% of patients in certain regions.Conclusion: In 2019, approximately 54,000 patients in Germany treated according to NVL/GINA step 4/5 had evidence suggestive for poor asthma control, up to 15% of patients in certain regions. Yet, only 12,000 patients overall were being treated with biologicals suggesting a possible treatment gap that requires further investigation.Keywords: prescription database, disease analyzer, uncontrolled asthma, oral corticosteroid, OCS, short-acting β 2-agonist, SABA

Keywords

• prescription database
• disease analyzer
• uncontrolled asthma
• oral corticosteroid (ocs)
• short-acting β2-agonist (saba).