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Buta F, Paoletti G, Bragato MC, Giovannini M, Canonica GW, Heffler E. Real-world evidence of allergen immunotherapy. Curr Opin Allergy Clin Immunol 2024:00130832-990000000-00151. [PMID: 39212626 DOI: 10.1097/aci.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW The full understanding of the long-term effectiveness and safety of allergen immunotherapy (AIT) for allergic respiratory diseases cannot be achieved through randomized controlled trials (RCTs) alone. However, real-world studies designed as registries can complement RCTs. RECENT FINDINGS The significance of registries is highlighted by their potential to reassess contraindications and collect data on adult and pediatric patients with multiple comorbidities who are often excluded from RCTs. SUMMARY AIT is the sole disease-modifying therapeutic approach capable of inducing tolerance and offering a long-term response to allergens. AIT has been shown to play a role in arresting the 'allergic march' in young people, which reduces the risk of developing asthmatic clinical manifestations. Although RCTs are considered the gold standard for evaluating the efficacy and safety of AIT, their duration is usually too short (seldom lasting more than 1 year) to assess the long-term effects of AIT. Several long-term studies show that AIT's effect depends strongly on its use duration.
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Affiliation(s)
- Federica Buta
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, Messina
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
| | - Maria Chiara Bragato
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
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Wan WJ, Xu QY, Lu MP, Lyu Q, Gu ZJ, Yuan J, Zhu XJ, Cui XY, Xu Q, Cheng L. Patient compliance to sublingual immunotherapy for mite-induced allergic rhinitis: A retrospective study. World Allergy Organ J 2024; 17:100926. [PMID: 39040084 PMCID: PMC11261089 DOI: 10.1016/j.waojou.2024.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/16/2024] [Accepted: 06/07/2024] [Indexed: 07/24/2024] Open
Abstract
Background Compliance to sublingual immunotherapy (SLIT) is generally low, resulting in reduced short- and long-term clinical efficacy. Compliance is a critical factor determining the success of allergic rhinitis (AR) treatment. Objective To analyze the compliance of patients with house dust mite (HDM)-induced AR to SLIT and the impact of coronavirus disease 2019 (COVID-19) on compliance. Methods The clinical data of 3117 patients with HDM-induced AR who started SLIT between July 2018 and April 2022 were retrospectively reviewed. We assessed the reasons for non-compliance and the changes in non-compliance during the COVID-19 pandemic compared to the pre-pandemic period. Results Of 3117 patients, 507 (16.27%) patients (ages, 5-67 years) were identified as non-compliant. The most common reason for non-compliance was poor efficacy (27.22%). The non-compliance rate was highest during 24-36 months of SLIT (28.13%, 153/544), followed by 12-24 months (7.02%, 91/1296). Non-compliance was significantly higher in adolescents/adults than in children (P = 0.000). Although the generalized linear model analysis indicated that compliance was affected by the COVID-19 pandemic during 3-6 months of SLIT, the overall compliance to SLIT was not significantly affected by the pandemic, according to the Kaplan-Meier survival analysis. Conclusions The non-compliance rate of SLIT in this study was low, and poor efficacy was the most common reason for non-compliance. The compliance of adolescents/adults was lower than that of children. The COVID-19 pandemic did not significantly impact compliance to SLIT, which is an appropriate strategy for the home treatment of AR patients during major public health events.
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Affiliation(s)
- Wen-Jin Wan
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Qiu-Yan Xu
- Department of Pediatrics, Suzhou Research Center of Medical School, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
| | - Mei-Ping Lu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Qian Lyu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zi-Jun Gu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Yuan
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xin-Jie Zhu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xin-Yan Cui
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
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Cardell LO, Sterner T, Ahmed W, Slættanes AK, Svärd M, Pollock RF. Modelling the impact of sublingual immunotherapy versus subcutaneous immunotherapy on patient travel time and CO 2 emissions in Sweden. Sci Rep 2024; 14:1575. [PMID: 38238479 PMCID: PMC10796394 DOI: 10.1038/s41598-024-51925-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
In Sweden, allergy immunotherapy (AIT) is available as either subcutaneous immunotherapy (SCIT) injections or sublingual immunotherapy (SLIT) tablets and is used to treat moderate-severe allergic rhinitis (AR). This study sought to determine treatment-related CO2 emissions and travel times in Swedish patients receiving either SCIT or SLIT-tablets. A list of specialized Swedish AR clinics that administer AIT was determined, and respective co-ordinates retrieved. Swedish municipality population data were obtained from a national database. The mean distance from each Swedish municipality to the nearest AR clinic was calculated, adjusted using a detour index, and weighted by estimated patient population size. Transport modality data were obtained from a Swedish urban transport study and CO2 emissions were obtained from Government sources. The mean number of annual SLIT-tablets and SCIT doses required were calculated based on product labels and clinical expert input. The annual number of healthcare professional interactions were layered into the model to estimate changes in mean patient travel time, distance, and travel-related CO2 emissions associated with using SCIT versus SLIT-tablets. Mean annual travel-related CO2 emissions were 410 tonnes (to two significant figures [s.f.]; standard deviation [SD] 90) with SLIT-tablets, versus 1700 tonnes (SD 380) for SCIT, resulting in mean annual savings of approximately 1300 tonnes (SD 290) of CO2 if all AIT patients were to receive SLIT-tablets instead of SCIT, over 380 times greater than 2021 average Swedish CO2 emissions per capita. Approximate mean annual travel times for patients taking SLIT-tablets were 66,500 h (three s.f.; SD 14,400), and 278,000 h (SD 60,200) for SCIT, resulting in mean annual savings of 211,000 h (SD 45,800) if all AIT patients were to receive SLIT-tablets instead of SCIT. Compared with SCIT injections, SLIT-tablets led to substantial reductions in treatment-related CO2 emissions and travel times for Swedish patients.
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Affiliation(s)
- Lars-Olaf Cardell
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Thomas Sterner
- Department of Economics, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Mikael Svärd
- ALK Nordic, Faktorvägen 9, SE-434 21, Kungsbacka, Sweden
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黄 蓉, 朱 晓, 汪 金. [Demographic features and compliance of children with allergic diseases receiving sublingual immunotherapy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1371-1375. [PMID: 36544421 PMCID: PMC9785092 DOI: 10.7499/j.issn.1008-8830.2207131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To study the demographic features of children with allergic diseases receiving standardized sublingual immunotherapy (SLIT) and the influencing factors for the compliance with SLIT. METHODS A retrospective analysis was performed on the demographic features and follow-up data of 1 789 children with allergic diseases who received SLIT in Children's Hospital of Jiangxi Province from January 1, 2018 to December 31, 2020. The compliance with SLIT and its influencing factors were analyzed. RESULTS A total of 1 789 children received SLIT, among whom there were 1 271 boys (71.05%) and 518 girls (28.95%), with an age range of 4-14 years. Among these children, 777 (43.43%) had complete compliance with SLIT and 1 012 (56.57%) withdrew from the treatment within one year. Among the 1 012 children, 354 (34.98%) withdrew from the treatment due to self-conscious inconvenient use, 346 (34.19%) withdrew due to unsatisfactory treatment outcome, 253 (25.00%) stopped the treatment due to the improvement in symptoms, and 59 (5.83%) terminated the treatment due to adverse reactions. Withdrawal was mainly observed within 1-4 months after treatment (74.31%, 752/1 012). Girls tended to have a lower compliance rate than boys, and the children with a single disease had a lower compliance rate than those with multiple diseases (P<0.05). The multivariate analysis showed that compared with boys, girls had an increased risk of withdrawal (OR=0.811, 95%CI: 0.658-0.998, P<0.05), and compared with the children with multiple diseases, the children with a single disease were more likely to withdraw from the treatment (OR=1.313, 95%CI: 1.005-1.715, P<0.05). CONCLUSIONS Children with allergic diseases tend to have poor compliance with SLIT, which is associated with sex and the number of diseases, and the main reasons for withdrawal are self-conscious inconvenient use and unsatisfactory treatment outcome.
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Hesse L, Oude Elberink J, van Oosterhout AJ, Nawijn MC. Allergen immunotherapy for allergic airway diseases: Use lessons from the past to design a brighter future. Pharmacol Ther 2022; 237:108115. [DOI: 10.1016/j.pharmthera.2022.108115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 12/23/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
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Chen H, Gong GQ, Ding M, Dong X, Sun YL, Wan L, Gao YD. Dropouts From Sublingual Immunotherapy and the Transition to Subcutaneous Immunotherapy in House Dust Mite-Sensitized Allergic Rhinitis Patients. FRONTIERS IN ALLERGY 2022; 2:810133. [PMID: 35386972 PMCID: PMC8974757 DOI: 10.3389/falgy.2021.810133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/30/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose: Both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are effective in reducing symptoms and medication scores and inducing long-term efficacy in patients with allergic rhinitis (AR). However, SLIT has been associated with poor patient adherence. This study investigates the factors impacting dropout rates from SLIT in house dust mite (HDM)-sensitized AR patients. Methods: A retrospective study was performed to analyze dropout rates and reasons in AR patients receiving Dermatophagoides farinae (Der f) SLIT with a follow-up period of 2 years. Results: A total of 719 HDM-sensitized AR patients received Der f-SLIT. Dropout rates increased with time and most occurred after 1 year of SLIT. By month 24, 654 (91%) patients had discontinued SLIT. The dropout rates by month 24 were 100, 90.1, and 91.1% in children <5 years old, children aged 5–18 years old, and adults ≥ 18 years old, respectively. Combination with allergic asthma and mono- or multi-sensitization to other aeroallergens did not affect the dropout rates. The most common self-reported reasons for dropouts were refusal of continuation, dissatisfaction with the efficacy, transition to SCIT, and adverse effects. Refusal of continuation increased with age, whereas transition to SCIT decreased with age. Ninety-seven cases transitioned from SLIT to SCIT, and the transition rates increased with time. Comorbid allergic asthma did not affect the transition rates. However, multi-sensitization was associated with a slightly higher rate of transition to SCIT. The most common reason for the transition was dissatisfaction with the efficacy (54.6%), which was only reported by patients older than 5 years. For children who began SLIT at younger than 5 years old, the most common reason (81.2%) for transition was age reaching 5 years. Conclusions: HDM-SLIT has a very high dropout rate, which is mainly due to refusal of continuation and dissatisfaction with the efficacy. Transitioning from SLIT to SCIT may help keep these patients on AIT and thus increase adherence and long-term efficacy.
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Affiliation(s)
- Huan Chen
- Department of Otolaryngology and Allergology, Central Hospital of Huangshi, Huangshi, China
| | - Guo-qing Gong
- Department of Otolaryngology and Allergology, Central Hospital of Huangshi, Huangshi, China
| | - Mei Ding
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
| | - Xiang Dong
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
| | - Yuan-li Sun
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
| | - Lang Wan
- Department of Otolaryngology and Allergology, Central Hospital of Huangshi, Huangshi, China
| | - Ya-dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
- *Correspondence: Ya-dong Gao
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Paoletti G, Di Bona D, Chu DK, Firinu D, Heffler E, Agache I, Jutel M, Klimek L, Pfaar O, Mösges R, DunnGalvin A, Genuneit J, Hoffmann HJ, Canonica GW. Allergen immunotherapy: The growing role of observational and randomized trial "Real-World Evidence". Allergy 2021; 76:2663-2672. [PMID: 33583050 DOI: 10.1111/all.14773] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although there is a considerable body of knowledge about allergen immunotherapy (AIT), there is a lack of data on the reliability of real-world evidence (RWE) in AIT, and consequently, a lack of information on how AIT effectively works in real life. METHODS To address the current unmet need for an appraisal of the quality of RWE in AIT, the European Academy of Allergy and Clinical Immunology Methodology Committee recently initiated a systematic review of observational studies of AIT, which will use the RELEVANT tool and the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE) to rate the quality of the evidence base as a whole. The next step will be to develop a broadly applicable, pragmatic "real-world" database using systematic data collection. Based on the current RWE base, and perspectives and recommendations of authorities and scientific societies, a hierarchy of RWE in AIT is proposed, which places pragmatic trials and registry data at the positions of highest level of evidence. KEY RESULTS There is a need to establish more AIT registries that collect data in a cohesive way, using standardized protocols. CONCLUSIONS This will provide an essential source of real-world data that can be easily shared, promoting evidence-based research and quality improvement in study design and clinical decision-making.
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Affiliation(s)
- Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
| | - Danilo Di Bona
- Department of Emergency and Organ Transplantation School and Chair of Allergology and Clinical Immunology University of Bari – Aldo Moro Bari Italy
| | - Derek K. Chu
- Division of Immunology and Allergy Department of Health Research Methods, Evidence and Impact Department of Medicine McMaster University Hamilton ON Canada
- The Research Institute of St. Joe's Hamilton Hamilton ON Canada
| | - Davide Firinu
- Department of Clinical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
| | - Ioana Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University of Brasov Brasov Romania
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University and “ALLMED”Medical Research Institute Wroclaw Poland
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy Department of Otorhinolaryngology, Head and Neck Surgery University Hospital MarburgPhilipps‐Universität Marburg Marburg Germany
| | - Ralph Mösges
- Faculty of Medicine Institute of Medical Statistics and Computational Biology (IMSB) University of Cologne and CRI – Clinical Research International Limited Cologne Germany
| | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics & Child Health University College Cork Cork Ireland
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry Ulm University Ulm Germany
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty Leipzig University Leipzig Germany
| | - Hans Jürgen Hoffmann
- Department of Clinical Medicine Aarhus University and Department of Respiratory Diseases and AllergyAarhus University Hospital Aarhus Denmark
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
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Pfaar O, Agache I, Bergmann K, Bindslev‐Jensen C, Bousquet J, Creticos PS, Devillier P, Durham SR, Hellings P, Kaul S, Kleine‐Tebbe J, Klimek L, Jacobsen L, Jutel M, Muraro A, Papadopoulos NG, Rief W, Scadding GK, Schedlowski M, Shamji MH, Sturm G, Ree R, Vidal C, Vieths S, Wedi B, Gerth van Wijk R, Frew AJ. Placebo effects in allergen immunotherapy-An EAACI Task Force Position Paper. Allergy 2021; 76:629-647. [PMID: 32324902 DOI: 10.1111/all.14331] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/18/2020] [Indexed: 12/12/2022]
Abstract
The placebo (Latin "I will please") effect commonly occurs in clinical trials. The psychological and physiological factors associated with patients' expectations about a treatment's positive and negative effects have yet to be well characterized, although a functional prefrontal cortex and intense bidirectional communication between the central nervous system and the immune system appear to be prerequisites for a placebo effect. The use of placebo raises certain ethical issues, especially if patients in a placebo group are denied an effective treatment for a long period of time. The placebo effect appears to be relatively large (up to 77%, relative to pretreatment scores) in controlled clinical trials of allergen immunotherapy (AIT), such as the pivotal, double-blind, placebo-controlled (DBPC) randomized clinical trials currently required by regulatory authorities worldwide. The European Academy of Allergy and Clinical Immunology (EAACI) therefore initiated a Task Force, in order to better understand the placebo effect in AIT and its specific role in comorbidities, blinding issues, adherence, measurement time points, variability and the natural course of the disease. In this Position Paper, the EAACI Task Force highlights several important topics regarding the placebo effect in AIT such as a) regulatory aspects, b) neuroimmunological and psychological mechanisms, c) placebo effect sizes in AIT trials, d) methodological limitations in AIT trial design and e) potential solutions in future AIT trial design. In conclusion, this Position Paper aims to examine the methodological problem of placebo in AIT from different aspects and also to highlight unmet needs and possible solutions for future trials.
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | | | - Karl‐Christian Bergmann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Germany
- Berlin Institute of Health Allergy‐Centre‐Charité Berlin Germany
| | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Research Center for Anaphylaxis (ORCA) Odense Denmark
| | - Jean Bousquet
- MACVIA‐France Montpellier France
- University Hospital Montpellier Montpellier France
| | - Peter S. Creticos
- Division of Allergy & Clinical Immunology Johns Hopkins University School of Medicine Baltimore MD USA
- Creticos Research Group Crownsville MD USA
| | - Philippe Devillier
- Department of Airway Diseases, Exhalomics, Hôpital Foch Université Paris‐Saclay Suresnes France
| | - Stephen R. Durham
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - Peter Hellings
- Department of Otorhinolaryngology University Hospitals of Leuven Leuven Belgium
- Department of Otorhinolaryngology Academic Medical Center University of Amsterdam Amsterdam The Netherlands
- Department of Neuroscience University of Ghent Ghent Belgium
| | - Susanne Kaul
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Jörg Kleine‐Tebbe
- Allergy & Asthma Center Westend Outpatient Clinic and Clinical Research Center Berlin Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Lars Jacobsen
- ALC, Allergy Learning and Consulting Copenhagen Denmark
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- All‐Med Medical Research Institute Wroclaw Poland
| | - Antonella Muraro
- Food Allergy Referral Centre Padua University Hospital Padua Padua Italy
| | - Nikolaos G. Papadopoulos
- Division of Infection Immunity & Respiratory Medicine University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy Philipps‐University of Marburg Marburg Germany
| | | | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology University Clinic Essen Essen Germany
| | - Mohamed H. Shamji
- National Heart and Lung Institute Imperial College London London UK
- NIHR Biomedical Research Centre Imperial College London London UK
| | - Gunter Sturm
- Department of Dermatology and Venereology Medical University of Graz Graz Austria
- Allergy Outpatient Clinic Reumannplatz Vienna Austria
| | - Ronald Ree
- Departments of Experimental Immunology and of Otorhinolaryngology Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Carmen Vidal
- Department of Allergy and Faculty of Medicine University of Santiago de Compostela Santiago Spain
| | - Stefan Vieths
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Bettina Wedi
- Department of Dermatology and Allergy Hannover Medical School Comprehensive Allergy Center Hannover Germany
| | - Roy Gerth van Wijk
- Section of Allergology Department of Internal Medicine Erasmus MC Rotterdam the Netherlands
| | - Anthony J. Frew
- Department of Respiratory Medicine Royal Sussex County Hospital University of Sussex and University of Brighton Brighton UK
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Borg M, Løkke A, Hilberg O. Geographical and socioeconomic differences in compliance with and access to allergen immunotherapy in Denmark: A nationwide registry-based study - 1998-2016. Respir Med 2021; 178:106332. [PMID: 33588210 DOI: 10.1016/j.rmed.2021.106332] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is a cost-effective treatment option in moderate-severe allergic rhino-conjunctivitis. Inequality in access to AIT and variation in compliance related to socioeconomic status or geographical location have not been described previously. OBJECTIVE The aim of the study was to evaluate access to grass pollen AIT at various educational attainment levels in the five regions of Denmark. Furthermore, grass pollen AIT treatment compliance was evaluated with respect to age, educational attainment and geographical area. METHODS The unique civil registration number of every citizen in Denmark was combined with the nationwide Danish National Health Service Prescription Database and Statistics Denmark Database to extract age, gender, residence and educational attainment of every citizen who collected prescribed AIT medication from 1998 to 2016. Then, compliance and use of AIT were calculated with respect to age, geographical location and educational attainment. RESULTS The use of subcutaneous AIT (SCIT) was significantly higher in the Capital Region; this difference was less predominant for sublingual AIT (SLIT). People who were educated only to primary school or vocational training levels were less frequent users of AIT. Compliance was especially low in the Capital Region and among people educated only to primary school level. In the age groups, compliance was similar, apart from SLIT users aged 0-9, for whom compliance was higher. CONCLUSION This nationwide study finds that SLIT has the potential to reduce inequality in access to AIT. A focus intervention is needed to facilitate access to and compliance with AIT in groups with lower socioeconomic status.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Anders Løkke
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
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Akinfenwa O, Rodríguez-Domínguez A, Vrtala S, Valenta R, Campana R. Novel vaccines for allergen-specific immunotherapy. Curr Opin Allergy Clin Immunol 2021; 21:86-99. [PMID: 33369572 PMCID: PMC7810419 DOI: 10.1097/aci.0000000000000706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Allergen-specific immunotherapy (AIT) is a highly economic, effective and disease-modifying form of allergy treatment but requires accurate prescription and monitoring. New molecular approaches are currently under development to improve AIT by reducing treatment-related side effects, cumbersome protocols and patients' compliance. We review the current advances regarding refined diagnosis for prescription and monitoring of AIT and the development of novel molecular vaccines for AIT. Finally, we discuss prophylactic application of AIT. RECENT FINDINGS There is evidence that molecular allergy diagnosis not only assists in the prescription and monitoring of AIT but also allows a refined selection of patients to increase the likelihood of treatment success. New data regarding the effects of AIT treatment with traditional allergen extracts by alternative routes have become available. Experimental approaches for AIT, such as virus-like particles and cell-based treatments have been described. New results from clinical trials performed with recombinant hypoallergens and passive immunization with allergen-specific antibodies highlight the importance of allergen-specific IgG antibodies for the effect of AIT and indicate opportunities for preventive allergen-specific vaccination. SUMMARY Molecular allergy diagnosis is useful for the prescription and monitoring of AIT and may improve the success of AIT. Results with molecular allergy vaccines and by passive immunization with allergen-specific IgG antibodies indicate the importance of allergen-specific IgG capable of blocking allergen recognition by IgE and IgE-mediated allergic inflammation as important mechanism for the success of AIT. New molecular vaccines may pave the road towards prophylactic allergen-specific vaccination.
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Affiliation(s)
- Oluwatoyin Akinfenwa
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Azahara Rodríguez-Domínguez
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Susanne Vrtala
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- NRC Institute of Immunology FMBA of Russia
- Laboratory for Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Raffaela Campana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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Liu W, Zeng Q, He C, Chen R, Tang Y, Yan S, Luo X, Luo R. Compliance, efficacy, and safety of subcutaneous and sublingual immunotherapy in children with allergic rhinitis. Pediatr Allergy Immunol 2021; 32:86-91. [PMID: 32810884 DOI: 10.1111/pai.13332] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/01/2020] [Accepted: 08/07/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although previous studies had confirmed the effectiveness and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), respectively, direct head-to-head comparison of SCIT vs SLIT is sparse. We aimed to compare the efficacy, safety, and compliance of SCIT and SLIT in allergic rhinitis (AR) children. METHODS This study is a prospective, open-label, and single-center study performed between June 2017 and June 2018. A total of 325 children were grouped into SLIT, Alutard (SCIT1), and NovoHelisen Depot (NHD) (SCIT2) according to the parents' wishes. The adherence and reasons for dropout were recorded. The efficacy of SLIT and SCIT was evaluated by a combined symptom medication score. Adverse events (AEs) were recorded and graded during the whole treatment. RESULTS The compliance rate was higher in the SCIT group compared with the SLIT group (P < .05). The total nasal symptom score (TNSS), rescue medication score (RMS), and symptom medication score (SMS) after 6-month, 12-month, and 2-year treatment were lower in the SCIT group compared with the SLIT group (P < .05). But the scores between the Alutard and NHD groups were not significantly different. The occurrence of AEs in the SCIT group was significantly higher compared with the SLIT group (P < .05). CONCLUSION Our results suggested SCIT is more effective compared with SLIT to a certain degree, whereas SLIT had less AEs compared with SCIT. The AIT routes can be chosen according to personal specific conditions.
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Affiliation(s)
- Wenlong Liu
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qingxiang Zeng
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chunhui He
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rongshan Chen
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yiquan Tang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shengbao Yan
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xi Luo
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Renzhong Luo
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Hura N, Song S, Kamil RJ, Pierre G, Lin SY. Predictors of Completion of Sublingual Immunotherapy. Laryngoscope 2020; 131:E2111-E2115. [PMID: 33179776 DOI: 10.1002/lary.29272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Sublingual immunotherapy (SLIT) has emerged as an effective treatment alternative to subcutaneous immunotherapy (SCIT) given its improved safety profile and more convenient dosing. However, SLIT still relies on daily dosing for many years to optimize effectiveness. This study sought to investigate factors that influence patient completion of SLIT. METHODS We performed an institutional retrospective review of patients who received SLIT (2008-2020). Completion was defined as completing at least 36 months of SLIT. Patient demographics and characteristics, including the number of allergens treated, history of asthma and sinus surgery, number of clinic visits, and total time undergoing SLIT, were documented. Multivariate models were used to analyze predictors of SLIT completion. Subgroup analysis was performed among pediatric patients and patients who discontinued SLIT. RESULTS Of the 404 total patients, 249 (61.6%) discontinued, 47 (11.6%) completed, and 108 (26.7%) were currently undergoing SLIT. The mean duration of therapy was 11.2 months for those who discontinued and 49.4 months for patients who completed SLIT. The odds of SLIT completion were twice as high with each additional clinic visit (P < .001), and twice as high when the dosage was increased during therapy (P = .06). Pediatric patients younger than age 12 with a history of asthma were over five times more likely to complete therapy (P = .045). Patients with more clinic visits (P < .001) and higher associated costs (P = .003) were less likely to be lost to follow-up. CONCLUSION Increasing the frequency of clinic visits, improving therapy availability, and mitigating concerns about clinical efficacy may increase patient completion of SLIT. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2111-E2115, 2021.
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Affiliation(s)
- Nanki Hura
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Sophia Song
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Rebecca J Kamil
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Gerdline Pierre
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Di Bona D, Bilancia M, Albanesi M, Caiaffa MF, Macchia L. Cost-effectiveness of grass pollen allergen immunotherapy in adults. Allergy 2020; 75:2319-2329. [PMID: 32096242 DOI: 10.1111/all.14246] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/21/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major scientific societies, such as the EAACI or the AAAAI, do not express any suggestion on which form of allergen immunotherapy (AIT) is to be preferred (subcutaneous immunotherapy, SCIT, vs sublingual immunotherapy, SLIT). This choice could depend on their relative pharmacoeconomic value. OBJECTIVE To assess the cost-effectiveness of AIT for grass pollen, administered as SCIT or SLIT. METHODS We created a Markovian Model, to evaluate, in a hypothetical cohort of adult patients suffering from moderate-to-severe rhino-conjunctivitis with or without allergic asthma, the cost-effectiveness of SLIT (tablets, Grazax® and Oralair® ) or SCIT (various currently available products, plus indirect nonmedical costs, such as travel and productivity costs) in addition to pharmacological therapy, assuming a 9-year horizon to capture AIT long-term effects. The incremental cost-effectiveness ratio (ICER) was calculated assuming pharmacological therapy as the reference comparator. RESULTS In the base case, SCIT was slightly more expensive, but more effective than SLIT, being the most cost-effective option (ICER for SCIT, €11 418; ICER for SLIT, €15 212). ICERs greater than €120 000 for both SCIT and SLIT were demonstrated in a scenario assuming that low treatment persistence rates, which are common in real-life, lead to absence of long-term AIT clinical benefit. Considering indirect nonmedical costs SLIT resulted more cost-effective than SCIT (ICER for SCIT, €17 318; ICER for SLIT, €15 212). CONCLUSION In daily practice, AIT for grass pollens may be a cost-effective option only in patients with low discontinuation rates. SCIT, which is less affected by this limitation than SLIT, seems the most cost-effective AIT form.
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Affiliation(s)
- Danilo Di Bona
- Department of Emergency and Organ Transplantation School and Chair of Allergology and Clinical Immunology University of Bari Aldo Moro Bari Italy
| | - Massimo Bilancia
- Ionic Department in Legal and Economic System of Mediterranean: Society, Environment, Culture University of Bari Aldo Moro Bari Italy
| | - Marcello Albanesi
- Department of Emergency and Organ Transplantation School and Chair of Allergology and Clinical Immunology University of Bari Aldo Moro Bari Italy
| | | | - Luigi Macchia
- Department of Emergency and Organ Transplantation School and Chair of Allergology and Clinical Immunology University of Bari Aldo Moro Bari Italy
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Jutel M, Brüggenjürgen B, Richter H, Vogelberg C. Real-world evidence of subcutaneous allergoid immunotherapy in house dust mite-induced allergic rhinitis and asthma. Allergy 2020; 75:2050-2058. [PMID: 32080856 DOI: 10.1111/all.14240] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The objective of this study was to analyze the effectiveness of allergen immunotherapy (AIT) with an allergoid in the treatment of house dust mites (HDM)-induced allergic rhinitis and/or asthma based on recent real-life data. The outcomes were measured using asthma incidence and consumption of corresponding medications as the indicator of persisting symptoms. METHODS In this retrospective cohort analysis of a German longitudinal prescription database, patients who received at least two relevant mite AIT prescriptions in two different successive seasonal cycles were compared with non-AIT patients who received at least three symptomatic allergic rhinitis (AR) prescriptions in successive mite seasons. Study endpoints included AR progression, asthma progression, asthma occurrence, and therapy adherence. We used multivariate regression analyses to estimate the effects of AIT, adjusting for relevant variables. RESULTS This study included 2350 patients receiving a mite allergoid and 64 740 control patients. After up to 6 years of follow-up, patients treated with mite allergoid required significantly fewer AR and asthma prescriptions (59.7% vs 10.8%) than the control group, and the probability of asthma development was significantly lower. The adherence of patients receiving allergoid was 63.8% at the end of the second year and 38.6% at the end of the third year. CONCLUSIONS This real-world evidence confirms the good efficacy of subcutaneous AIT with HDM mite allergoid in the treatment of allergic rhinitis and/or asthma. Up to 6 years of follow-up revealed significant effects in allergic rhinitis by measuring the number of AR medications and demonstrating significant reductions in asthma medications.
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Affiliation(s)
- Marek Jutel
- All‐MED Medical Research Institute Wrocław Poland
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
| | | | | | - Christian Vogelberg
- Department of Pneumology and Allergology, Carl Gustav Carus University Clinic Dresden Germany
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Schworer SA, Kim EH. Sublingual immunotherapy for food allergy and its future directions. Immunotherapy 2020; 12:921-931. [PMID: 32611211 DOI: 10.2217/imt-2020-0123] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Food allergy is an important medical problem with increasing prevalence throughout the world. Different approaches of food immunotherapy are being investigated including oral, epicutaneous and sublingual routes. Sublingual immunotherapy (SLIT) for food allergy involves placement of glycerinated allergen under the tongue daily to achieve allergen-specific desensitization. SLIT has been studied in the treatment of hazelnut, peach, apple, milk and peanut allergies with substantial focus on the treatment of peanut allergy. Phase II studies have shown SLIT for treatment of peanut allergy increases the tolerated dose of peanut by a substantial margin with fewer and less severe side effects than other modalities. This review discusses the mechanisms of SLIT, early studies of its use in food allergy and larger randomized controlled trials for treatment of peanut allergy. Future directions using the mechanisms involved in SLIT include oral mucosal immunotherapy for peanut allergy.
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Affiliation(s)
- Stephen A Schworer
- Department of Medicine, Division of Rheumatology, Allergy & Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Edwin H Kim
- Department of Medicine, Division of Rheumatology, Allergy & Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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Borg M, Løkke A, Hilberg O. Compliance in subcutaneous and sublingual allergen immunotherapy: A nationwide study. Respir Med 2020; 170:106039. [PMID: 32843170 DOI: 10.1016/j.rmed.2020.106039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/22/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Allergic rhino-conjunctivitis is a highly prevalent condition. In moderate to severe cases, allergen immunotherapy (AIT) is a cost-effective therapeutic option. Previous data have reported a large difference in treatment compliance of subcutaneously (SCIT) and sublingually (SLIT) administered AIT. METHODS By use of the unique civil registration number assigned to all Danish citizens and the Danish National Health Service Prescription Database, compliance rates of all patients prescribed with grass pollen AIT from January 1998 until December 2016 were analysed annually during the three-year treatment period. RESULTS The male/female ratio was close to 1:1 in SCIT, while SLIT was more frequently used by men. A large proportion of users was children or adolescents (32% and 45%, SCIT and SLIT, respectively). Compliance of both subcutaneous and sublingual treatment gradually fell each year; compliance in year 3 was 57% and 53% for subcutaneous and sublingual treatment, respectively. Compliance of grass pollen sublingual treatment was also analysed each year after registration on the Danish market. Compliance significantly increased following the introduction and stabilised on a relatively high level. CONCLUSION Based on previous studies, we hypothesised that AIT compliance would be low, especially in SLIT. However, in Denmark, compliance in SCIT and SLIT was almost similar, and the majority of patients completed the three-year treatment period with a compliance in the last quintile.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Anders Løkke
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
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Bilancia M, Pasculli G, Di Bona D. A non-stationary Markov model for economic evaluation of grass pollen allergoid immunotherapy. PLoS One 2020; 15:e0232753. [PMID: 32407326 PMCID: PMC7224467 DOI: 10.1371/journal.pone.0232753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/21/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction Allergic rhino-conjunctivitis (ARC) is an IgE-mediated disease that occurs after exposure to indoor or outdoor allergens, or to non-specific triggers. Effective treatment options for seasonal ARC are available, but the economic aspects and burden of these therapies are not of secondary importance, also considered that the prevalence of ARC has been estimated at 23% in Europe. For these reasons, we propose a novel flexible cost-effectiveness analysis (CEA) model, intended to provide healthcare professionals and policymakers with useful information aimed at cost-effective interventions for grass-pollen induced allergic rhino-conjunctivitis (ARC). Methods Treatments compared are: 1. no AIT, first-line symptomatic drug-therapy with no allergoid immunotherapy (AIT). 2. SCIT, subcutaneous immunotherapy. 3. SLIT, sublingual immunotherapy. The proposed model is a non-stationary Markovian model, that is flexible enough to reflect those treatment-related problems often encountered in real-life and clinical practice, but that cannot be adequately represented in randomized clinical trials (RCTs). At the same time, we described in detail all the structural elements of the model as well as its input parameters, in order to minimize any issue of transparency and facilitate the reproducibility and circulation of the results among researchers. Results Using the no AIT strategy as a comparator, and the Incremental Cost Effectiveness Ratio (ICER) as a statistic to summarize the cost-effectiveness of a health care intervention, we could conclude that: Conclusions Even though there is a considerable evidence that SCIT outperforms SLIT, we could not state that both SCIT and SLIT (or only one of these two) can be considered cost-effective for ARC, as a reliable threshold value for cost-effectiveness set by national regulatory agencies for pharmaceutical products is missing. Moreover, the impact of model input parameters uncertainty on the reliability of our conclusions needs to be investigated further.
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Affiliation(s)
- Massimo Bilancia
- Ionic Department in Legal and Economic System of Mediterranean (DJSGEM), University of Bari Aldo Moro, Taranto, Italy
- * E-mail:
| | - Giuseppe Pasculli
- Department of Computer, Control, and Management Engineering Antonio Ruberti (DIAG), La Sapienza University, Rome, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
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Passalacqua G, Bagnasco D, Canonica GW. 30 years of sublingual immunotherapy. Allergy 2020; 75:1107-1120. [PMID: 31715001 DOI: 10.1111/all.14113] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/28/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
Allergen Immunotherapy (AIT) was introduced in clinical practice on an empirical basis more than 100 years ago. Since the first attempts, AIT was administered subcutaneously. Indeed, other routes of administration were proposed and studied, in particular to improve the safety, but only the sublingual route (SLIT) achieved a credibility based on evidence and was then accepted as a viable "alternative" option to the subcutaneous route. SLIT was largely used in clinical trials and clinical practice in this last 30 years. Thus, a large amount of data is available, coming from either controlled trials and postmarketing surveillance studies. It is clear that SLIT is overall effective, but it is also clear that the efficacy is not "class-related," as derived from meta-analyses, but restricted to each specific product. The 30-year lasting use of SLIT allowed to clarify many clinical aspects, such as efficacy, safety, use in asthma, regimens of administration, and optimal doses. In parallel, the mechanisms of action of AIT were elucidated, and new indications were proposed (eg food allergy, atopic dermatitis). In addition, the introduction of molecular-based diagnosis, allowed to better refine the prescription of SLIT, based on specific sensitization profiles. The present article will describe the origin and evolution of SLIT for respiratory allergy, taking into account the clinical context that suggested this form of treatment, the recently developed aspects, the future perspectives and unmet needs, This is not, therefore, a systematic review, rather a narrative historical description of the past history, and a look forward to the future opportunities.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
- Personalized Medicine Asthma & Allergy ‐ Humanitas Clinical and Research Center IRCCS Rozzano (MI) Italy
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Jin M, Zhang L, Zhou G, Zhang S, Li X, Hu S. The effect of the standard length of the first prescription on the adherence to sublingual immunotherapy for patients with allergic rhinitis. Int Forum Allergy Rhinol 2020; 10:768-772. [PMID: 32223075 DOI: 10.1002/alr.22553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Poor adherence to sublingual immunotherapy (SLIT) has become a major cause of unsatisfactory clinical efficacy for patients with allergic rhinitis (AR). This study was designed to identify the effect of different first prescription lengths on the adherence to SLIT. METHODS The clinical data of 306 patients with AR who started SLIT between January 2017 and June 2018 were retrospectively reviewed. Patients were divided into 3 groups according to the length of their first prescription (group A: less than 3 months, group B: 3 to 6 months, group C: more than 6 months). The numbers of adherent or nonadherent patients in each group and the main reasons of nonadherence were analyzed. RESULTS Groups A, B, and C included 102, 161, and 43 patients, respectively. The average lengths of the first prescription for group A, B, and C were 62.52 ± 17.63, 102.21 ± 9.22, and 189.07 ± 17.97 days. There were significance differences among the 3 groups (p < 0.05). There were 42 (41.18%), 112 (69.57%), and 37 (86.05%) adherent patients in group A, B, and C. There were 60 (58.82%), 49 (30.43%), and 6 (13.95%) nonadherent patients in group A, B, and C. There were significant differences in the proportions of adherent and nonadherent patients among the 3 groups (p < 0.05). The following reasons were cited for nonadherence to SLIT: the long course of SLIT; inconvenience of getting the prescription; ineffectiveness; side effects; and other reasons. CONCLUSION Under certain conditions, 6 months is recommended as the standard length for the first prescription, which can significantly improve adherence to SLIT in patients with AR.
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Affiliation(s)
- Mao Jin
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Lei Zhang
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Guojin Zhou
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Shoude Zhang
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Xuan Li
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Sunhong Hu
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
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Devillier P, Demoly P, Molimard M. Allergen immunotherapy: what is the added value of real-world evidence from retrospective claims database studies? Expert Rev Respir Med 2020; 14:445-452. [PMID: 32131649 DOI: 10.1080/17476348.2020.1733417] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Randomized controlled trials (RCTs) show that allergen immunotherapy (AIT) has proven long-term efficacy in patients with allergic rhinitis (AR). However, RCTs have limited generalizability and there is growing recognition that real-world evidence (RWE) is necessary to provide complementary data to those of RCTs, and corroborate their findings. Until recently, data from the real-world setting investigating the benefits of AIT for the treatment of patients with grass and birch pollen-associated AR were sparse, but new retrospective claims database studies from France and Germany have confirmed the sustained benefits of grass and birch pollen AIT in terms of significantly reduced progression of AR and asthma, and a significantly decreased risk of new-onset asthma.Areas covered: Here, we review the value of RWE used alongside data from traditional RCTs, and its potential strengths and limitations, and summarize the findings of the recent RWE studies investigating the benefits of AIT for the management of patients with grass and birch pollen-associated AR.Expert opinion: There is growing recognition of the necessity and value of RWE as a complement to data acquired in RCTs, to better understand the effects of AIT treatments in a broader, more representative patient population, and to help guide clinical decision-making.
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Affiliation(s)
- Philippe Devillier
- UPRES EA 220, Department of Airway Diseases, Hôpital Foch, University of Versailles Saint Quentin, University Paris-Saclay, Suresnes, France
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud De Villeneuve, University Hospital of Montpellier, Montpellier, France and Equipe EPAR - IPLESP, Sorbonne Université, Paris, France
| | - Mathieu Molimard
- Pharmacology Department, University of Bordeaux, INSERM Unit CR1219, Bordeaux, France
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Vogelberg C, Brüggenjürgen B, Richter H, Jutel M. Real-World Adherence and Evidence of Subcutaneous and Sublingual Immunotherapy in Grass and Tree Pollen-Induced Allergic Rhinitis and Asthma. Patient Prefer Adherence 2020; 14:817-827. [PMID: 32494127 PMCID: PMC7231771 DOI: 10.2147/ppa.s242957] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Allergen immunotherapy (AIT), when continued for 3 years, is the only disease-modifying treatment for AR and asthma. Adherence is a key to ensure effectiveness, and poor adherence is a contraindication for AIT. The objective of this study was to evaluate real-world adherence to AIT with subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) preparations in patients allergic to grass or tree pollen. The impact of AIT on the consumption of asthma and rhinitis medication was also analyzed. PATIENTS AND METHODS In this retrospective cohort analysis of a German longitudinal prescription database, the adherence of a grass and tree pollen allergoid was examined and compared to two sublingual AIT tablets/drops. Patients receiving grass or tree allergen-specific immunotherapy prescriptions were compared with non-AIT patients receiving symptomatic allergic rhinitis (AR) and asthma prescriptions. The study endpoints included therapy adherence, AR progression, and asthma progression. Multivariate regression analyses were used to estimate the effects of SCIT or SLIT, adjusting for variables related to demographics and prescriptions. RESULTS SCIT adherence was 60.1-61.8% at 2 years and 35.0-37.5% at 3 years for the two allergens. SLIT adherence was distinctly lower (29.5-36.5% and 9.6-18.2%, respectively). Adherence in children was higher compared to adolescents or adults. All products were highly efficacious at reducing symptomatic AR medication consumption. SCIT also reduced asthma medication use for both allergens, whereas for SLIT these results were significant only for grasses but not trees. CONCLUSION Subcutaneous AIT in a real-world setting achieved significantly higher adherence rates compared to sublingual administration. SCIT reduced the use of rhinitis and asthma medication significantly for both allergens, while SLIT reduced the use of rhinitis medication for both allergens and the use of asthma medication for grasses only.
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Affiliation(s)
- Christian Vogelberg
- Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
- Correspondence: Christian Vogelberg University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, Dresden01307, GermanyTel +49 351 458-5699Fax +49 351 458-4334 Email
| | - Bernd Brüggenjürgen
- Institute for Health Economics, Steinbeis University Berlin, Berlin, Germany
| | | | - Marek Jutel
- All-MED Medical Research Institute, Warsaw, Poland
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
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Bousquet J, Ansotegui IJ, Anto JM, Arnavielhe S, Bachert C, Basagaña X, Bédard A, Bedbrook A, Bonini M, Bosnic-Anticevich S, Braido F, Cardona V, Czarlewski W, Cruz AA, Demoly P, De Vries G, Dramburg S, Mathieu-Dupas E, Erhola M, Fokkens WJ, Fonseca JA, Haahtela T, Hellings PW, Illario M, Ivancevich JC, Jormanainen V, Klimek L, Kuna P, Kvedariene V, Laune D, Larenas-Linnemann D, Lourenço O, Onorato GL, Matricardi PM, Melén E, Mullol J, Papadopoulos NG, Pfaar O, Pham-Thi N, Sheikh A, Tan R, To T, Tomazic PV, Toppila-Salmi S, Tripodi S, Wallace D, Valiulis A, van Eerd M, Ventura MT, Yorgancioglu A, Zuberbier T. Mobile Technology in Allergic Rhinitis: Evolution in Management or Revolution in Health and Care? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:2511-2523. [PMID: 31445223 DOI: 10.1016/j.jaip.2019.07.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/02/2019] [Accepted: 07/25/2019] [Indexed: 01/08/2023]
Abstract
Smart devices and Internet-based applications (apps) are largely used in allergic rhinitis and may help to address some unmet needs. However, these new tools need to first of all be tested for privacy rules, acceptability, usability, and cost-effectiveness. Second, they should be evaluated in the frame of the digital transformation of health, their impact on health care delivery, and health outcomes. This review (1) summarizes some existing mobile health apps for allergic rhinitis and reviews those in which testing has been published, (2) discusses apps that include risk factors of allergic rhinitis, (3) examines the impact of mobile health apps in phenotype discovery, (4) provides real-world evidence for care pathways, and finally (5) discusses mobile health tools enabling the digital transformation of health and care, empowering citizens, and building a healthier society.
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Affiliation(s)
- Jean Bousquet
- University Hospital, Montpellier, France; MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France; VIMA, INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France; Euforea, Brussels, Belgium; Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany.
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Erandio, Spain
| | - Josep M Anto
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - Xavier Basagaña
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Annabelle Bédard
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Anna Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | - Matteo Bonini
- UOC Pneumologia, Istituto di Medicina Interna, F Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; National Heart and Lung Institute, Royal Brompton Hospital & Imperial College London, London, United Kingdom
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia; Woolcock Emphysema Centre and Sydney Local Health District, Glebe, NSW, Australia
| | - Fulvio Braido
- Department of Internal Medicine (DiMI), University of Genoa, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Vicky Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain
| | | | - Alvaro A Cruz
- ProAR-Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil; WHO GARD Planning Group, Salvador, Brazil
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Equipe EPAR-IPLESP, Sorbonne Université, Paris, France
| | | | - Stephanie Dramburg
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | | | - Marina Erhola
- National Institute for Health and Welfare, Helsinki, Finland
| | - Wytske J Fokkens
- Euforea, Brussels, Belgium; Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, the Netherlands
| | - Joao A Fonseca
- CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Medida, Lda, Porto, Portugal
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Peter W Hellings
- Euforea, Brussels, Belgium; Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium; Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maddalena Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | | | | | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Désirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Olga Lourenço
- Faculty of Health Sciences and CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | | | - Paolo M Matricardi
- AG Molecular Allergology and Immunomodulation, Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - Erik Melén
- E. Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Nikos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Marburg, Germany
| | - Nhân Pham-Thi
- Allergy Department, Pasteur Institute, Paris, France
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel Tan
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia; Woolcock Emphysema Centre and Sydney Local Health District, Glebe, NSW, Australia
| | - Teresa To
- Sidkkids Hospital and Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
| | | | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Fla
| | - Arunas Valiulis
- Institute of Clinical Medicine, Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania; Institute of Health Sciences, Department of Public Health, Vilnius University, Vilnius, Lithuania; European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | | | - Maria Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, Berlin, Germany; Corporate member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Berlin, Germany; Member of GA(2)LEN, Berlin, Germany
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23
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Mösges R, Breitrück NY, Allekotte S, Shah-Hosseini K, Dao VA, Zieglmayer P, Birkholz K, Hess M, Bastl M, Bastl K, Berger U, Kramer MF, Guethoff S. Shortened up-dosing with sublingual immunotherapy drops containing tree allergens is well tolerated and elicits dose-dependent clinical effects during the first pollen season. World Allergy Organ J 2019; 12:100012. [PMID: 30937138 PMCID: PMC6439405 DOI: 10.1016/j.waojou.2019.100012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/06/2018] [Accepted: 01/07/2019] [Indexed: 02/05/2023] Open
Abstract
Background This study compared a rapid home-based up-dosing schedule for sublingual immunotherapy (SLIT) drops containing tree pollen allergens with two previously established schedules. Furthermore, the clinical effect of the SLIT was investigated with respect to patients’ first pollen season under treatment. Methods In this open-label, prospective, patient-preference, non-interventional study, local and systemic reactions were compared between three up-dosing groups using a SLIT formulation containing birch, alder, and hazel pollen extracts (ORALVAC® Compact Bäume). Clinical improvement after patients’ first season under treatment was analysed using symptom scores, ARIA classification, symptom control, and the use of symptomatic medication and was compared with data from the previous, pre-treatment pollen season. As the real-life study design allowed no placebo group, the late-treated patients (co-seasonal) served as a control, and crowd-sourced symptom data from persons with hay fever were used from a free web-based online diary. Results In 33 study centres in Germany and Austria, 164 patients were included. The treatment was well tolerated, without difference between the groups during the up-dosing phase. At the end of the assessment, 96.1% rated the tolerability of the treatment as good or very good. Local reactions were mostly mild in severity and no serious adverse events occurred. Symptom scores decreased from the 2016 pollen season to the 2017 pollen season. As for the ARIA classification, 79.0% of patients had persistent, moderate-to-severe rhinitis before treatment, but only 18.6% had the same classification after treatment. In all, 62.4% of patients achieved symptom control, and 34.3% of patients required no symptomatic medication after treatment. The rhinoconjunctivitis score was 34.4% lower for pre-seasonal treatment initiation than for the control group. Crowd-sourced symptom load indices showed that the 2016 season caused slightly more symptoms; however, it is assumed that this difference of 0.3–0.5 (score range 0–10) was of less clinical relevance. Conclusion The treatment administered using the rapid home-based up-dosing schedule was safe and well tolerated. Symptom relief and reduction in medication use were observed during the first pollen season with SLIT. Trial registration number NCT03097432 (clinicaltrials.gov).
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Key Words
- AE, adverse event
- ARIA, Allergic Rhinitis and its Impact on Asthma
- Adherence
- Asthma
- Conjunctivitis
- IgE, immunoglobulin E
- Immunotherapy
- N, number
- PHD, Patient's Hay Fever Diary
- Pollen allergy
- Pre-seasonal
- RCAT, Rhinitis Control Assessment Test
- Rhinitis
- SD, standard deviation
- SLI, symptom load index
- SLIT
- SLIT, sublingual immunotherapy
- SmPC, Summary of Product Characteristics
- Sublingual immunotherapy
- TU, therapeutic units
- V, visit
- sIgE, specific immunoglobulin E
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Affiliation(s)
- Ralph Mösges
- Institute of Medical Statistics, Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany
- CRI - Clinical Research International Ltd., Cologne, Germany
| | - Nils Y Breitrück
- Institute of Medical Statistics, Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Silke Allekotte
- CRI - Clinical Research International Ltd., Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics, Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Van-Anh Dao
- CRI - Clinical Research International Ltd., Cologne, Germany
| | | | | | - Mark Hess
- CRI - Clinical Research International Ltd., Cologne, Germany
| | - Maximilian Bastl
- Department of Oto-Rhino-Laryngology, Research Group Aerobiology and Pollen Information, Medical University of Vienna, Vienna, Austria
| | - Katharina Bastl
- Department of Oto-Rhino-Laryngology, Research Group Aerobiology and Pollen Information, Medical University of Vienna, Vienna, Austria
| | - Uwe Berger
- Department of Oto-Rhino-Laryngology, Research Group Aerobiology and Pollen Information, Medical University of Vienna, Vienna, Austria
| | - Matthias F Kramer
- Bencard Allergie GmbH, Munich, Germany
- Allergy Therapeutics, Worthing, United Kingdom
| | - Sonja Guethoff
- Bencard Allergie GmbH, Munich, Germany
- Allergy Therapeutics, Worthing, United Kingdom
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24
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Imanaka T, Sato I, Kawasaki Y, Kanazawa Y, Kawakami K. An analysis of factors associated with compliance and dropout of sublingual immunotherapy on Japanese cedar pollinosis patients. Int Forum Allergy Rhinol 2019; 9:615-623. [PMID: 31173675 DOI: 10.1002/alr.22308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sublingual immunotherapy (SLIT) is safe and effective but compliance is problematic. In this study we evaluated dropout and compliance among adults (≥20 years of age) and adolescents (<20 years of age) for Japanese cedar pollen extract (JCPE), an aqueous SLIT approved in 2014 in Japan. METHODS Administrative claims data on 1236 Japanese patients, 846 adults (mean age, 43.0 years; 41.8% female) and 249 adolescents (mean age, 14.1 years; 36.6% female), with a JCPE prescription between October 2014 and June 2016 were reviewed. Adults and adolescents were divided according to the year they started SLIT (1- and 2-year cohorts) to calculate dropout and compliance and identify associated factors using multivariate Cox and linear regression models. RESULTS In 1- and 2-year adult cohorts, dropout rates were 13.5% and 22.1% and compliance rates were 92.8% and 88.8%, respectively. Adolescents had higher dropout and lower compliance. Patients 40-59 years of age had a lower dropout risk than patients 20-29 years of age. Dropout hazard ratios (95% confidence interval) in 1- and 2-year cohorts were 0.26 (0.12-0.58) and 0.40 (0.17-0.93) in patients 40-49 years of age and 0.32 (0.14-0.75) and 0.35 (0.13-0.92) in patients 50-59 years of age, respectively. Younger age contributed to lower compliance in 1- and 2-year adult cohorts (p = 0.001 and p = 0.02, respectively). Systemic steroidal medication history and male gender were positively associated with compliance in adults but not in adolescents. CONCLUSION High dropout rate was associated with younger generations. Compliance in adults, but not in adolescents, was associated with age, systemic steroidal medication history, and gender.
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Affiliation(s)
- Takahiro Imanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan.,Research and Development Division, Santen Pharmaceutical Co., Ltd., Ofuka-cho, Kita-ku, Osaka, Japan
| | - Izumi Sato
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan.,Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research, Yoshida-Honmachi, Sakyo-ku Kyoto-shi, Kyoto, Japan
| | - Yohei Kawasaki
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan.,Biostatistics Section, Clinical Research Center, Chiba University Hospital, Inohana, Chuo-ku, Chiba, Japan
| | - Yuji Kanazawa
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan.,Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan
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25
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Baiardini I, Novakova S, Mihaicuta S, Oguzulgen IK, Canonica GW. Adherence to treatment in allergic respiratory diseases. Expert Rev Respir Med 2018; 13:53-62. [PMID: 30518277 DOI: 10.1080/17476348.2019.1554438] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Asthma and allergic rhinitis (AR) are chronic conditions in which management needs adherence to prescribed drugs. Despite the benefits of regular maintenance of asthma and AR therapy, low adherence is a frequent issue in clinical practice. Areas covered: The aim of this review is to provide a targeted analysis of the more recent literature on adherence in asthma and AR, focused on the following areas: adherence extent, barriers and consequences, effects of educational interventions and use of new technologies to improve the level of adherence. Expert commentary: Despite the extent, reasons and effects of this problem being well known, non-adherence in asthma and allergic AR remains worryingly high. Poor adherence leads to unsatisfactory health outcomes, with a negative impact on patients and society. Recent literature suggests that successful programs to improve adherence should include a combination of strategies. The new technologies represent a promising tool to improve adherence.
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Affiliation(s)
- Ilaria Baiardini
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy
| | - Silviya Novakova
- b Allergy Unit of Internal Consulting Department , University Hospital "St. George" , Plovdiv , Bulgaria
| | - Stefan Mihaicuta
- c Pulmonology Department, CardioPrevent Foundation , University of Medicine and Pharmacy "Dr Victor Babes" , Timisoara , Romania
| | | | - Giorgio Walter Canonica
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy.,e Personalized Medicine, Asthma and Allergy Clinic , Humanitas Research Hospital, Milano, Italy
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26
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Novak N, Buhl T, Pfaar O. Adherence During Early Allergen Immunotherapy and Strategies to Motivate and Support Patients. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10312545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Allergic rhinitis is one of the most common chronic inflammatory conditions, affecting up to 30% of people in Europe. Allergen immunotherapy (AIT) is the only treatment for allergic rhinitis and asthma that has a disease-modifying effect, and it is recommended in European guidelines for use in conjunction with patient education, specific allergen avoidance, and symptomatic pharmacotherapy. Reported AIT adherence rates vary widely but are often low in real-world settings. Factors known to affect adherence are patient, treatment, or physician-related, and vary between healthcare settings. Misconceptions or a lack of AIT knowledge among patients with regard to efficacy and side effects may contribute to high rates of discontinuation observed during the first year of AIT treatment. Interventions to improve patient adherence are multifaceted and should focus on patient education, particularly the provision of accurate information regarding adverse effects of AIT and when to expect an improvement in symptoms, patient-support programmes, and the use of regular eHealth reminders via a telephone call, text message, or social media. Serum-based biomarkers also have the potential to play a role in evaluating early response to AIT and in monitoring treatment adherence in clinical practice. In this review, the authors explore barriers to continuation with AIT and discuss initiatives to motivate and support patients through the challenging early months of treatment, prior to the onset of clinical effect and when side effects are most common, to encourage long-term adherence to therapy and achieve optimal patient outcomes.
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Affiliation(s)
- Natalija Novak
- Department of Dermatology and Allergy, University of Bonn Medical Center, Bonn, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Georg-August University, Göttingen, Germany; Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen and University of Osnabrück, Osnabrück, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
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27
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Molnár V, Nagy A, Tamási L, Gálffy G, Böcskei R, Bikov A, Czaller I, Csoma Z, Krasznai M, Csáki C, Zsigmond G, Csontos Z, Kurucz A, Kurucz E, Fábos B, Bálint BL, Sasvári-Székely M, Székely A, Kótyuk E, Kozma GT, Cserta G, Farkas A, Gál Z, Gézsi A, Millinghoffer A, Antal P, Szalai C. From genomes to diaries: a 3-year prospective, real-life study of ragweed-specific sublingual immunotherapy. Immunotherapy 2018; 9:1279-1294. [PMID: 29130793 DOI: 10.2217/imt-2017-0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
During the last decades, the prevalence of allergy has dramatically increased. Allergen-specific immunotherapy is the only currently available medical intervention that has the potential to affect the natural course of the disease, but there are still many questions and unmet needs hindering its widespread use to fulfill its treatment potential and maximize its benefits for the society. To provide a comprehensive phenome-wide overview in sublingual immunotherapy, using ragweed allergy as a target, we planned and carried out a longitudinal, prospective, observational, open-label study (DesensIT). In this paper we present challenges of using deep and comprehensive phenotypes embracing biological, clinical and patient-reported outcomes in allergen-specific immunotherapy and show how we designed the DesensIT project to optimize data collection, processing and evaluation.
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Affiliation(s)
- Viktor Molnár
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Adrienne Nagy
- Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Renáta Böcskei
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - András Bikov
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Ibolya Czaller
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Zsuzsanna Csoma
- National Korányi Institute of TB & Pulmonology, 1121 Budapest, Pihenő út 1, Hungary
| | - Magdolna Krasznai
- Department of Otorhinolaryngology, Semmelweis University, Head & Neck Surgery, 1083 Budapest, Szigony u. 36, Hungary
| | - Csilla Csáki
- Svábhegyi Healing Facility, 1037 Budapest, Bokor u. 17, Hungary
| | | | - Zoltán Csontos
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Anikó Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Edina Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Beáta Fábos
- Somogy County Kaposi Mór Teaching Hospital, 7400 Kaposvár Tallián Gyula u. 20-32, Hungary
| | - Bálint L Bálint
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary
| | - Mária Sasvári-Székely
- Institute of Medical Chemistry, Molecular Biology & Pathobiochemistry, Semmelweis University, 1094 Budapest, Tűzoltó utca 37-47, Hungary
| | - Anna Székely
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Eszter Kótyuk
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Gergely T Kozma
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Gábor Cserta
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Anita Farkas
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Zsófia Gál
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Gézsi
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Millinghoffer
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary.,Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Péter Antal
- Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Csaba Szalai
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary.,Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary.,Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
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28
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Janson C, Sundbom F, Arvidsson P, Kämpe M. Sublingual grass allergen specific immunotherapy: a retrospective study of clinical outcome and discontinuation. Clin Mol Allergy 2018; 16:14. [PMID: 29930483 PMCID: PMC5994102 DOI: 10.1186/s12948-018-0093-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/30/2018] [Indexed: 01/10/2023] Open
Abstract
Background Sublingual immunotherapy (SLIT) is effective, tolerable, and convenient for many allergic patients. Still, real-world evidence is scarce and the aim of this study is to assess the patient reported outcome of treatment with SLIT against grass pollen allergy in a consecutive patient population. Methods Patients (n = 329) who were confirmed to be allergic to timothy grass and had been prescribed SLIT were consecutively enrolled in the study and completed a questionnaire online or in hard copy. Results 207 (62.9%) patients responded to the questionnaire. The female/male ratio was 105/102 with a mean age of 39 ± 11 years (range 19–70 years). 113 (55%) patients reported they had completed the full 3-year treatment period, 49 (24%) were still on treatment, and 45 (22%) had discontinued treatment prematurely. Respondents who had completed the full treatment period reported that their allergy symptoms in the most recent grass pollen season had improved to a larger extent than subjects still on treatment or discontinuing the treatment prematurely. Improvement of asthma was twice as common among patients who completed compared to discontinued treatment (42 vs. 20%). Younger age (37 ± 12 vs. 41 ± 11 years, p < 0.001) and a higher prevalence of reported oral and/or gastrointestinal side effects (49 vs. 24%, p = 0.02) characterised the group that terminated SLIT. Forgetfulness was the most commonly reported specific reason. Conclusion Treatment perseverance resulted in improved patient reported outcome. Forgetfulness was the most frequently reported reason for discontinuing SLIT treatment against grass pollen allergy.
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Affiliation(s)
- Christer Janson
- 1Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Fredrik Sundbom
- 1Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | | | - Mary Kämpe
- 1Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
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Subcutaneous allergen immunotherapy may be a suitable treatment for exacerbator allergic asthma. Ann Allergy Asthma Immunol 2018; 121:258-259. [PMID: 29803710 DOI: 10.1016/j.anai.2018.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/04/2018] [Accepted: 05/18/2018] [Indexed: 11/22/2022]
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Brüggenjürgen B, Reinhold T. Cost-effectiveness of grass pollen subcutaneous immunotherapy (SCIT) compared to sublingual immunotherapy (SLIT) and symptomatic treatment in Austria, Spain, and Switzerland. J Med Econ 2018; 21:374-381. [PMID: 29271271 DOI: 10.1080/13696998.2017.1419959] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND While specific immunotherapy (SIT) has been proven to be cost-effective for the treatment of allergic rhinitis compared to symptomatic treatment, there is a lack of European studies in which sublingual (SLIT) and subcutaneous (SCIT) immunotherapy were compared. The present analysis is focused on the cost-effectiveness of SCIT compared to SLIT and symptomatic treatment of grass pollen allergy in Austria, Spain, and Switzerland. It will address specific properties of the underlying healthcare systems. METHODS The investigation is based on a previously published health economic model calculation. This was designed as a Markov model with pre-defined health stages and a duration of 9 years covering specific preparations for SCIT (Allergovit) and SLIT (Oralair). The effectiveness was assessed as symptom-score based quality-adjusted life years (QALYs). Additionally, total cost has been determined as well as the cost-effectiveness of SCIT. The robustness of model results was proved in further sensitivity analyses. RESULTS With regard to the effectiveness of both SCIT and SLIT, preparations were dominant compared to pharmacological symptomatic therapy. Both strategies were associated with additional cost, but, combined with the results on effectiveness, both have to be regarded as cost-effective. A direct comparison of the SCIT (Allergovit) and SLIT (Oralair) showed lower total costs of SCIT vs SLIT for Austria, Spain, and Switzerland (€1,368 vs €2,012, €2,229 vs €2,547, and €1,901 vs €2,220) and superior effectiveness (SCIT =8.02 QALYs; SLIT =7.98 QALYs; and symptomatic therapy =7.90 QALYs). CONCLUSION In patients with allergic rhinitis, SIT offers cost-effective treatment options compared to symptomatic treatment. When comparing SCIT (Allergovit) and SLIT (Oralair), SCIT was dominant in terms of QALYs as well as costs, in particular due to a slightly higher patient compliance and lower drug costs.
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Affiliation(s)
- Bernd Brüggenjürgen
- a Institute for Health Economics, Steinbeis-Hochschule Berlin (SHB) , Berlin , Germany
| | - Thomas Reinhold
- b Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin , Germany
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Smith WB, Kette FE. Allergen immunotherapy for respiratory allergic disease in Australia in 2016. Med J Aust 2018; 206:60-61. [PMID: 28152347 DOI: 10.5694/mja16.00953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/16/2016] [Indexed: 11/17/2022]
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Lombardi C, Melli V, Incorvaia C, Ridolo E. Pharmacoeconomics of sublingual immunotherapy with the 5-grass pollen tablets for seasonal allergic rhinitis. Clin Mol Allergy 2017; 15:5. [PMID: 28286421 PMCID: PMC5340071 DOI: 10.1186/s12948-017-0058-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 01/04/2017] [Indexed: 12/16/2022] Open
Abstract
Allergic rhinitis has a very high burden regarding both direct and indirect costs. This makes essential in the management of AR to reduce the clinical severity of the disease and thus to lessen its costs. This particularly concerns allergen immunotherapy (AIT), that, based on its immunological action on the causes of allergy, extends its benefit also after discontinuation of the treatment. From the pharmacoeconomic point of view, any treatment must be evaluated according to its cost-effectiveness, that is, the ratio between the cost of the intervention and its effect. A favorable cost-benefit ratio for AIT was defined, starting from the first studies in the 1990s on subcutaneous immunotherapy (SCIT) in AR patients, that highlighted a clear advantage on costs over the treatment with symptomatic drugs. Such outcome was confirmed also for sublingual immunotherapy (SLIT), that has also the advantage on SCIT to be free of the cost of the injections. Here we review the available literature on pharmacoeconomic data for SLIT with the 5-grass pollen tablets.
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Affiliation(s)
- Carlo Lombardi
- Allergy and Pneumology Departmental Unit, Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Valerie Melli
- Department of Clinical & Experimental Medicine, University of Parma, Via Gramsci 14, Parma, Italy
| | | | - Erminia Ridolo
- Department of Clinical & Experimental Medicine, University of Parma, Via Gramsci 14, Parma, Italy
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Abstract
Allergies are steadily gaining in importance in the Western world. For over one hundred years, immunology has been the only causal treatment. Specific immunotherapy (SIT) aims at the cure of allergy or at least freedom from allergy symptoms. In association with this, adherence poses a complex problem. Both treatment applications commonly used in Germany-sublingual and subcutaneous immunotherapy-show poor persistence on the part of the patients. In most cases, SIT is not carried out to the end of the recommended duration and instead is discontinued prematurely. Corresponding figures from 3‑year studies in the literature range from 41- 93% for uncompleted SLIT and from 40-77% for uncompleted SCIT. Patient adherence is subject to influencing factors of various dimensions that are interdependent in complex relationships. The physician-patient relationship is just as decisive a factor for treatment success as the patient's understanding of allergy, treatment, and the importance of adherence.
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Wang T, Li Y, Wang F, Zhou C. Nonadherence to sublingual immunotherapy in allergic rhinitis: a real-life analysis. Int Forum Allergy Rhinol 2017; 7:389-392. [PMID: 28151587 DOI: 10.1002/alr.21909] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/23/2016] [Accepted: 12/13/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND To sustain the long-lasting beneficial effects of allergen-specific sublingual immunotherapy (SLIT), an adequate duration of treatment is required. Nevertheless, many patients discontinue prematurely and therefore fail to obtain satisfactory therapeutic effect in clinical practice. The aim of this study was to analyze the causes leading to premature discontinuation of SLIT in allergic rhinitis (AR), and to provide the corresponding countermeasures for the following SLIT course. METHODS We performed a retrospective analysis of data from 142 patients with AR who started SLIT during the period from December 2009 to February 2015. Patients were contacted at 1, 3, 6, and 12 months into SLIT as part of our standard of care. The patients who claimed to have stopped treatment were asked to provide a reason during one of the phone calls. RESULTS Overall, 76 (54%) patients with AR terminated immunotherapy during the first year of treatment. Among the 76 patients, the following reasons were cited for nonadherence to immunotherapy: patients could not be reached (25%); ineffectiveness (24%); the long course (18%); improvement of symptoms (13%); side effects (4%); lack of confidence in the treatment (4%); or other reasons (12%). CONCLUSION Fifty-four percent of AR patients terminated their treatment within the first year of SLIT. The top reasons for treatment discontinuation included patients not be reached, ineffectiveness, and length of course.
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Affiliation(s)
- Ting Wang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yue Li
- Department of Otorhinolaryngology, The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Feng Wang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chengyong Zhou
- Department of Otorhinolaryngology, The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
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Aissa S, Ben Jazia R, Ayachi J, Ben Salem C, Hayouni A, Abdelghani A, Ben Saad H, Boussarsar M. Critical appraisal of the clinical utility of sublingual immunotherapy in allergy. Contemp Clin Trials Commun 2016; 4:1-8. [PMID: 29736465 PMCID: PMC5935903 DOI: 10.1016/j.conctc.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 11/30/2022] Open
Abstract
Since it was introduced by Noon in 1911, allergen-specific immunotherapy or desensitization has been widely prescribed in the management of allergic diseases. Aimed at the etiology, it represents the only effective treatment for allergy. The basic mechanisms of immunotherapy are becoming better understood and allow us to improve this technique in the future. The sublingual immunotherapy as an alternative to subcutaneous route has been widely studied. Several clinical trials confirmed that sublingual immunotherapy is efficient in reducing allergic respiratory symptoms. The sublingual immunotherapy reduces the risk of developing serious side effects due to desensitization. We performed a literature review in order to remind the mechanisms of action and to demonstrate efficacy and tolerability of the sublingual immunotherapy in the treatment of allergic rhinoconjunctivitis and asthma and its impact on the quality of life.
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Affiliation(s)
- S. Aissa
- Pulmonology Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - R. Ben Jazia
- Pulmonology Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - J. Ayachi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - C. Ben Salem
- Department of Clinical Pharmacology, Faculty of Medicine of Sousse, Tunisia
| | - A. Hayouni
- Pulmonology Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - A. Abdelghani
- Pulmonology Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - H. Ben Saad
- Laboratory of Physiology, Farhat Hached University Hospital, Sousse, Tunisia
| | - M. Boussarsar
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
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Lemberg ML, Eberle P, Shah-Hosseini K. Importance of Quality of Life for Adherence to Sublingual Immunotherapy. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5186765. [PMID: 27504453 PMCID: PMC4967702 DOI: 10.1155/2016/5186765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/18/2016] [Accepted: 06/23/2016] [Indexed: 11/22/2022]
Abstract
Background. Nonperception of efficacy ranks among the most commonly cited causes for nonadherence to sublingual immunotherapy (SLIT). Quality of life (QoL) in patients is a determining factor influencing adherence. We investigated QoL and adherence separately in SLIT patients at one pediatric practice in Germany. Methods. We conducted a noninterventional, cross-sectional, retrospective, quality-of-life survey among pediatric patients treated with SLIT. QoL was assessed using the generic SF-12 health survey in German. The items contained in the SF-12 health survey are weighted, added up, and converted to obtain a physical component score (PCS) and a mental component score (MCS). Each component score ranges from 0 to 100; the higher the score, the better the QoL perceived. Results. 201 surveyed patients who had undergone SLIT showed PCS-12 of 49.3 (± 7.0) and MCS-12 of 52.6 (± 7.2). These figures correlate strongly with those reported for the German general population (n = 2453): PCS-12 of 49.6 (± 8.7) and MCS-12 of 52.3 (± 8.0). 70.2% (73) of 104 patients were adherent at this practice. Conclusions. QoL in the SLIT patients surveyed here appears as good as that of the general population. Adherence to SLIT at this practice was remarkably better than that reported elsewhere.
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Affiliation(s)
- Marie-Luise Lemberg
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
| | - Peter Eberle
- Pediatric Practice for Pneumology/Allergology, Wilhelmshöher Allee 109, 34121 Kassel, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany
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