Abstract
SummaryPurposeAllergen immunotherapy (AIT) is the only disease-modifying treatment for allergic rhinitis (AR) and asthma (AA) with increasing efficacy observed during the recommended 3 years of treatment and the potential for medium and long-term benefits. Adherence is of utmost importance to achieve these goals in real life. The objective of this study was to evaluate real-world adherence to house dust mite (HDM) AIT with a subcutaneous (SCIT) allergoid preparation and a sublingual (SLIT) tablet.Patients and methodsIn this retrospective cohort analysis of a German longitudinal prescription database, patients receiving either a HDM-SCIT allergoid (n = 5677) or a HDM-SLIT tablet (n = 4720) were compared over a 3-year observation period. Study endpoints included adherence and days on therapy (DoT). Univariate statistical tests were used to assess the significance of the differences between SCIT vs. SLIT or the age classes.ResultsBased on the number of reimbursed prescriptions SCIT adherence was 55.0% after 3 years while SLIT adherence was remarkably lower with 30.3% (p < 0.0001). The difference was observed already after first and second year of treatment and was in favor of SCIT with 93.2% vs. 63.2% and 70.9% vs. 43.4%, respectively. After 3 years, days on therapy were significantly higher in the SCIT group with 824 days vs. 491 days (p < 0.0001) showing significantly better data for all age groups. Adherence to SCIT was the highest in children, followed by adolescents and adults while the adherence to SLIT was higher in adults than adolescents.ConclusionIn this retrospective real-world cohort analysis in Germany, patients on subcutaneous AIT for HDM respiratory allergy achieved significantly higher adherence rates compared to the HDM-SLIT tablet over a 3-year treatment period. In addition, days on therapy were significantly higher for SCIT than for SLIT. It was shown that in real life significantly more patients receiving SCIT stay on the recommended treatment period of 3 years compared to SLIT subjects. This is important since effectiveness has been demonstrated to be linked with therapy duration.
Highlights
Respiratory allergic diseases including allergic rhinitis (AR) and allergic asthma (AA) demonstrate increase in prevalence rates worldwide and are underrecognized for their impact on health and daily living [1]
Based on the number of reimbursed prescriptions SCIT adherence was 55.0% after 3 years while SLIT adherence was remarkably lower with 30.3% (p < 0.0001)
In this retrospective real-world cohort analysis in Germany, patients on subcutaneous Allergen immunotherapy (AIT) for house dust mite (HDM) respiratory allergy achieved significantly higher adherence rates compared to the HDM-SLIT tablet over a 3-year treatment period
Summary
Respiratory allergic diseases including allergic rhinitis (AR) and allergic asthma (AA) demonstrate increase in prevalence rates worldwide and are underrecognized for their impact on health and daily living [1]. AR affects the nose and possibly the eyes, resulting in a chronic, mostly eosinophilic, inflammation of the nasal mucosa and conjunctiva. It may be associated with sinusitis, hearing problems, and asthma. Even if there are no asthmatic symptoms at the beginning, AR can develop into AA over time. During AIT, the immune system develops tolerance to the triggering allergen due to the activation of allergen specific T regulatory cells subsets with the following desensitization measured by decreased IgE and increased IgG4. In addition to desensitization and thereby ameliorating symptoms, AIT delivers long-term clinical benefits that may persist for years after discontinuation of the treatment and prevents the development of asthma [2, 5, 6]. Its efficacy in allergic rhinoconjunctivitis and asthma has been well established in several meta-analyses comprising many randomized controlled studies [7, 8]
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