Optimizing severe asthma care by consulting an asthma expertise team for biologics

<bold>Background:</bold> Biologics target specific type 2-inflammatory pathways in people with severe asthma (PwSA) and reduce asthma attacks (AA) as well as oral corticosteroids maintenance dose (OCSm). Biologic indication is complex. Online consultation of an Asthma Expertise Team (AETc) can improve biologic indication and select the best fit. <bold>Objectives:</bold> To assess the impact of AETc on 1) medical costs associated with biologic indication for PwSA, 2) biologic indication and the extent in asthma remission in PwSA. <bold>Methods:</bold> Data of 389 PwSA indicated for biologics, who were discussed between 2016 and 2021 by the local AETc or online by the AETc with specialists from 10 regional hospitals, were collected. The AETc were led by Asthma Expertise Center of Amsterdam UMC. Remission was assessed by evaluating effect parameters after 4-6 months. <bold>Results:</bold> 1) Biologics were indicated for 155 of 243 (64%) PwSA. There was no indication in 88 PwSA (36%), resulting in an estimated average cost saving of €243k/y and total estimated savings of €3.5M over 5.5y. 2) The biological treatment of 146 PwSA (49% male, 72% adult-onset, 59% non-allergic) consisted of 35% dupilumab, 29% mepolizumab, 15% benralizumab, 11% reslizumab, and 10% omalizumab. Biologics significantly improved clinical parameters compared to baseline by AA, OCSm, FEV1 and ACQ (all p<0.001). Evaluation showed that 93% of PwSA continued treatment and 7% stopped due to lack of effectiveness. <bold>Conclusions:</bold> Online AETc results in effective and efficient prescription of biologics for PwSA. It enhances the effectiveness of biologics through careful indication, resulting in cost reduction and medication sustainability.