Adherence in allergen immunotherapy: Current situation and future implications

Gehrt, Francesca; Xu, Qingqing; Baiardini, Ilaria; Canonica, Giorgio Walter; Pfaar, Oliver

doi:10.5414/alx02318e

Cited by 15 publications

(8 citation statements)

References 71 publications

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“…RWE studies are increasingly expected to play an important role in the future and to complement RCTs in the assessment of safety and effectiveness in order to provide a comprehensive picture of the ‘real world’. 17 , 26 , 27 , 28 Paoletti et al . 17 recently published a systematic review of observational studies of AIT calling for appraisal of the quality and importance of RWE in AIT.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…17,[26][27][28] Paoletti et al17 recently published a systematic review of observational studies of AIT calling for appraisal of the quality and importance of RWE in AIT. They underline the need for further collaborations to standardize the methodology for RWE studies.…”

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confidence: 99%

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Persistence in allergen immunotherapy: A longitudinal, prescription data‐based real‐world analysis

Pfaar

Richter²,

Sager

et al. 2023

Clinical & Translational All

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Introduction Allergic rhinitis (AR) is a widespread disease with increasing prevalence in developed countries. The only treatment that tackles the underlying causes is allergen immunotherapy (AIT). This treatment is performed through two application routes, the subcutaneous immunotherapy (SCIT) or the sublingual immunotherapy (SLIT). However, persistence during the long course of treatment over 3 years is key for the efficacy of this treatment option. The impaired adherence significantly impacts public health resources. The aim of this study was to assess the persistence of AIT for both application routes. Methods IQVIA TM LRx was used to identify patients starting AIT between 2009 and 2018 with grass pollen (GP), early flowering tree pollen (EFTP) and house dust mite (HDM) allergens. Patients were classified within each allergen category by AIT groups (subcutaneous depigmented polymerised allergen AIT [dSCIT], other subcutaneous AIT [oSCIT] and SLIT) and age (5‐11 years, 12‐17 years, 18+ years). Furthermore, they were followed up for up to 3 years until the cessation of treatment. Patients, who were still on treatment after 3 years were deemed to be censored. Kaplan‐Meier curves of persistence were generated and compared by log‐rank tests. Results The number of patients included in the three allergen categories was 38,717 GP, 23,183 EFTP, and 41,728 HDM AIT. In all allergen categories and for any product group, patient persistence decreased with increasing age class with the difference between 5‐11 years and 12‐17 years greater than between the latter and 18+ years. The percentage of patients completing the first year of AIT was low, particularly for SLIT where 22.2%–27.1% of patients remained persistent after 12 months. The equivalent figures for dSCIT were 52.0%–64.1% and for oSCIT 38.3%–50.3%. Conclusion Persistence in AIT in AR was low in this retrospective prescription‐based database and was clearly linked to patient age and application route.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Persistence in allergen immunotherapy: A longitudinal, prescription data‐based real‐world analysis

Pfaar

Richter²,

Sager

et al. 2023

Clinical & Translational All

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“…6 Non-adherence to AIT is a critical issue, as suboptimal adherence can lead to reduced efficacy. [7][8][9] A review of literature from four decades has identified more than 10 different terms describing medication-taking behaviour and deviations from prescribed treatment, including adherence, compliance and persistence; notably, there was no uniformity in the terms used. 10 In general, adherence refers to the overall process by which patients take their medication as agreed with their healthcare provider (Figure 1), whilst compliance refers to the implementation of the dosing regimen, defined as the extent to which a patient's actual dosing aligns with the prescribed dosing regimen.…”

Section: Introductionmentioning

confidence: 99%

“…forgetting to take medication, poor understanding of the treatment regimen) 6 . Non‐adherence to AIT is a critical issue, as suboptimal adherence can lead to reduced efficacy 7–9 …”

Section: Introductionmentioning

confidence: 99%

Adherence and persistence in allergen immunotherapy (APAIT): A reporting checklist for retrospective studies

Pfaar

Devillier

Schmitt

et al. 2023

Allergy

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Background Adherence is essential for the long‐term efficacy of allergen immunotherapy (AIT) and has been evaluated in numerous retrospective studies. However, there are no published guidelines for best practice in measuring and reporting adherence or persistence to AIT, which has resulted in substantial heterogeneity among existing studies. The ‘adherence and persistence in AIT (APAIT)’ checklist has been developed to guide the reporting, design and interpretation of retrospective studies that evaluate adherence or persistence to AIT in clinical practice. Methods Five existing checklists, focussing on study protocol design, the use of retrospective databases/patient registries, and the appraisal and reporting of observational studies, were identified and merged. Relevant items were selected and tailored to be specific to AIT. The content of the checklist was discussed by 11 experts from Europe, the United States and Canada, representing allergy, healthcare and life sciences, and health technology appraisal. Results The APAIT checklist presents a set of items that should either be included or at least considered, when reporting retrospective studies that assess adherence or persistence to AIT. Items are organized into four categories comprising study objective, design and methods, data analysis, and results and discussion. The checklist highlights the need for clarity and transparency in reporting and emphasizes the importance of considering potential sources of bias in retrospective studies evaluating adherence or persistence to AIT. Conclusions The APAIT checklist provides a pragmatic guide for reporting retrospective adherence and persistence studies in AIT. Importantly, it identifies potential sources of bias and discusses how these influence outcomes.

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House dust mite immunotherapy: A real‐world, prescription data‐based analysis

Mösges,

Richter,

Sager

et al. 2024

Clinical & Translational All

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BackgroundHouse dust mite (HDM) sensitisation can contribute to the development of allergic rhinoconjunctivitis (AR) or allergic asthma (AA). As treatment, allergen immunotherapy (AIT) is a promising approach, since it aims building immunotolerance against allergens, therewith establishing long‐term efficacy. The evaluation of AIT has been investigated in many randomised controlled trials, whereas few real‐world evidence studies are available.MethodsWe used data from the longitudinal prescription data base IQVIA™ LRx. Data on initial AIT prescriptions against HDM from January 2009 to December 2013 was analysed regarding treatment (subcutaneous AIT with either depigmented polymerised allergen extract [dSCIT] or other allergens [oSCIT], or sublingual immunotherapy [SLIT]) and treatment duration. Treatment groups were compared with a control group of AR patients not receiving AIT. Data on symptomatic medication was collected until February 2017 and progression of AR and AA was compared.ResultsData of 7260 patients with AIT prescriptions and of 21,780 control patients was analysed. AIT was associated with a significant decrease of AR medication intake compared with control (dSCIT: −34.0%, p < 0.0001; oSCIT: −25.7%, p < 0.0001; SLIT: −37.7%, p = 0.0026). In asthmatics, SCIT was associated with a significant decrease of asthma medication compared with control (dSCIT: −45.2%, p < 0.0001; oSCIT: −32.9%, p < 0.0001). Further, a significantly reduced likelihood for onset of asthma medication was demonstrated in patients treated with SCIT compared with controls (dSCIT OR: 0.759, p = 0.0476; oSCIT OR: 0.815, p = 0.0339).ConclusionReal‐world data analyses indicate that AIT, particularly given via a subcutaneous route, reduces the need of medication against AR and AA and might delay the onset of asthma medication in patients with AR.

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Adherence in allergen immunotherapy: Current situation and future implications

Cited by 15 publications

References 71 publications

Persistence in allergen immunotherapy: A longitudinal, prescription data‐based real‐world analysis

Persistence in allergen immunotherapy: A longitudinal, prescription data‐based real‐world analysis

Adherence and persistence in allergen immunotherapy (APAIT): A reporting checklist for retrospective studies

House dust mite immunotherapy: A real‐world, prescription data‐based analysis

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