Severe asthma biologics use in England: a need to increase use and reduce inequity

<bold>Background:</bold> Severe asthma (SA) is associated with significant disease and treatment related comorbidity. Asthma biologics can be transformative, reducing oral steroid reliance. In England, biologics are initiated in specialist centres. <bold>Aim:</bold> Assess the degree of regional variation in biologic prescribing across England to support the need for interventions that can improve access. <bold>Method:</bold> Data (BlueTeq: national recording system) on the initiation/use of biologic treatments in eligible patients (based on regional asthma prevalence) in England between 2016 and 2023 were obtained for all 42 Integrated Care Boards (ICBs). Future use based on current initiation rates was calculated using an arbitrary target of 50% of biologic-eligible patients actually receiving biologics. Practice-change initiatives were evaluated. <bold>Results:</bold> Between 2016 and 2023, SA biologic prescribing in England varied widely by ICB; 2 and 29% (15-fold difference) of eligible patients received biologics (national mean 17±5%). Based on current initiation rates, modelling indicates that it will take 36 years (December 2061) for 50% of eligible patients to be on biologic therapy. Identification of patients with SA using primary care search tools led to a 3-fold increase in biologic initiation in one region.¹ Accelerating home care use also reduces time to start biologics.² Integrating care between specialist centres and primary care can also support more timely and higher biologic initiation. <bold>Conclusion:</bold> In England, biologics are underused among eligible SA patients, with concerning regional variability. Whole pathway changes are needed for achievable improvements. 1. Minshall et al. ERJ 2023;62 suppl 67 2. Whitfield et al. BTS 2023;P38