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Hiroyuki Nagase,1 Urvee Karsanji,2 Hideaki Kunishige,3 Takeo Suzuki,4 Anna Vichiendilokkul,5 Liza Yuanita,6 Natsuki Sasakura,6 Jiaxuan Wang,7 Saeed Noibi8 1Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan; 2Real World Biostatistics, GSK, London, UK; 3Global Real-World Evidence & Health Outcomes Research, GSK, Tokyo, Japan; 4Real World Data Analytics, GSK, Tokyo, Japan; 5Global Medical Affairs, GSK, Collegeville, PA, USA; 6Japan Medical Affairs, GSK, Tokyo, Japan; 7Cytel Inc., Vancouver, BC, Canada; 8Global Real-World Evidence & Health Outcomes Research, GSK, Jeddah, Saudi ArabiaCorrespondence: Hiroyuki Nagase, Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan, Email nagaseh@med.teikyo-u.ac.jpPurpose: Biologic therapies have improved clinical outcomes and quality of life in patients with asthma, and treatment adherence is important for their effectiveness. This study evaluated 12-month adherence patterns for five asthma biologics approved in Japan and their impact on clinical and economic outcomes in patients with severe asthma.Methods: This non-interventional, cross-sectional, retrospective cohort study used Japan’s Medical Data Vision database (June 2009–September 2024). Adults with severe asthma, ≥ 30 days of continuous enrollment pre-biologic initiation and ≥ 12 months of follow-up were included. Adherence was assessed using medication possession ratio (MPR). Group-based trajectory modeling (GBTM) characterized distinct adherence trajectories over time, providing insights into heterogeneous adherence behaviors and subgroup patterns. Impact of biologic adherence on exacerbations (defined by hospital admissions, emergency department visits or requiring oral/intravenous corticosteroids), healthcare resource utilization (HCRU) and pharmacy costs were analyzed descriptively.Results: Among 2904 eligible patients, average MPR was 62.6%– 72.6% across the five biologics. Over 90% of patients received ≥ 1 follow-up dose of their biologic; with average MPR increased by 1%– 6% among these patients versus the overall cohort. The GBTM analysis was conducted in 2531 patients without a biologic switch during follow-up, identifying seven distinct clusters with MPR ranging from 10.0% to 94.8%. Patients were also classified as adherent (41.1%), partially adherent (28.1%), minimally adherent (3.2%), or treatment discontinuation (27.6%), based on dosing frequency and intervals. Mean exacerbation rates defined by hospital admissions were low (0.02– 0.08 events per patient/year). Exacerbations of any type typically increased with declining biologic adherence. Decreased adherence was generally associated with increased HCRU and higher asthma-related pharmacy costs, particularly when biologic costs were excluded.Conclusion: Biologic adherence was consistently associated with fewer exacerbations, reduced HCRU and lower asthma-related pharmacy costs (excluding biologic costs), reinforcing the importance of optimizing adherence in patients with asthma.Plain Language Summary: Patients with severe asthma may have flare-ups (called asthma exacerbations), even when using standard treatments like inhaled steroids. For these patients, doctors may prescribe biologics which can reduce the number or severity of asthma exacerbations and are generally safer than long-term systemic corticosteroid use. However, biologics work best when taken as prescribed. This study investigated how well adults with severe asthma in Japan followed their prescribed biologic treatments (adherence to treatment). Also, the study investigated what the impact of adherence to treatment was on asthma exacerbations, need for healthcare support and pharmacy costs. The study researchers used health records from 2009 to 2024 to identify patients who started one of five biologics approved for asthma in Japan. Adherence was measured over 1 year by checking how often patients collected their biologic therapy (known as “medication possession ratio” [MPR]). Based on how often patients collected their medicine, they were categorized as adherent, partially adherent, minimally adherent, or treatment discontinuation (stopped collecting their medicine). The researchers also used a method called “group-based trajectory modeling” (GBTM) which identifies different patterns of missed doses over time. This identified seven different patterns of missed doses over time, including patients who stayed adherent, those who gradually collected their medicine less, and those who stopped collecting it for long periods. The number of asthma exacerbations, healthcare use, and pharmacy costs were then compared among patients in these different adherence groups. Patients who took their biologic as prescribed had fewer asthma exacerbations, needed less healthcare support, and had lower asthma-related pharmacy costs compared with those who did not. These results highlight the importance of taking biologic treatments consistently for patients with severe asthma to reduce the disease and economic burden. Keywords: Asthma biologics, biologic adherence, cost analysis, exacerbations, group-based trajectory modeling, healthcare resource utilization