Suggested updated approaches to patient management

Findings from an Online Survey Assessing the Burden and Management of Seasonal Allergic Rhinoconjunctivitis in US Patients

BACKGROUND

Seasonal allergic rhinoconjunctivitis (SARC) affects ≥16% of the US population annually. Telephone and in-office surveys have demonstrated negative effects of allergic rhinitis (AR) symptoms on sleep, daily activities, productivity, concentration, and emotions.

OBJECTIVE

The objective of this study was to assess the patient-perceived burden of SARC in relation to newer treatments, increased access to treatments, and changing management protocols.

METHODS

An online survey of symptom experience, impact on daily life, and management was conducted in US respondents who suffer (or whose child suffers) from SARC symptoms.

RESULTS

A total of 1001 surveys were completed: 500 adults (≥18 years old) and 501 children (12-17 years old, documented by their parents). Similar to earlier AR surveys, SARC symptoms negatively affected the patient's (and family's) quality of life, and were most severe in the spring. Before being treated, >50% of respondents reported daily symptoms during their season; 75% to 80% considered their symptoms moderate to severe. Patients saw a variety of health care professionals (including pharmacists) and used over-the-counter and prescription medications for symptoms. Those using prescription medications were generally more satisfied with treatment and less likely to switch or discontinue treatment. Nasal and/or ocular symptoms drove adherence, seeing a health care professional, and reviewing and/or changing treatment.

CONCLUSIONS

The majority of patients with SARC report moderate-to-severe symptoms that significantly impair their quality of life. However, patients appear to be taking more responsibility for their (child's) condition, and patient expectations for therapy are increasingly being met. Continued efforts will be needed to examine the contribution of better information and/or increased access to and availability of medications to control the disease.

Intranasal spray medications for maintenance therapy of allergic rhinitis

BACKGROUND

Intranasal sprays are recommended as targeted therapy for allergic rhinitis (AR) by providing direct delivery of medication to the nasal mucosa, reducing the potential for systemic adverse effects, decreasing burden of disease, and improving quality of life.

OBJECTIVE

To review currently available intranasal sprays indicated for maintenance therapy of AR in the United States: intranasal antihistamines (INAH); intranasal corticosteroids (INCS); and MP-AzeFlu, a single formulation nasal spray of the INAH, azelastine hydrochloride, and the INCS, fluticasone propionate.

METHODS

MEDLINE searches were conducted to identify placebo-controlled studies of commercially available prescription nasal sprays at U.S.-approved doses and indications, and published after an earlier systematic review of AR treatment. Inclusion criteria were ≥20 subjects; duration of ≥2 weeks for seasonal (or episodic) AR, ≥4 weeks for perennial (or persistent) AR, and reporting a total nasal symptom score as a primary or secondary outcome.

RESULTS

Twenty studies met the inclusion criteria: 4 pediatric, 16 adult/adolescent. There were 4 perennial AR studies (381 children, 1607 adults) and 16 seasonal AR trials (3081 children, 6548 adults). In these studies, 2451 subjects (481 children, 1970 adults) received an INCS, 3001 (1116 children, 1885 adults) received an INAH, and 346 adult subjects received MP-AzeFlu. All active treatments were well tolerated and effective as measured by the reduction in nasal symptoms. Head-to-head comparisons were only available for MP-AzeFlu versus the individual active agent components. MP-AzeFlu provided significantly greater symptom relief than either azelastine or fluticasone propionate alone and with an onset starting at 30 minutes after the dose.

CONCLUSION

The most recent addition to intranasal sprays for the maintenance therapy of AR is MP-AzeFlu, a single formulation nasal spray of azelastine hydrochloride and fluticasone propionate in an advanced delivery system. Analysis of clinical data showed this to be the first new intranasal medication that provides greater clinical benefit than an INCS in treating AR.