Administration and Burden of Subcutaneous Immunotherapy for Allergic Rhinitis in U.S. and Canadian Clinical Practice

Abstract

Analyses revealed substantial variation in SCIT regimens among sites, but the sites had commonalities in the injection process components. SCIT requires patient commitment to a long-term treatment regimen involving numerous clinic visits and resources for administration.

Sublingual immunotherapy tablet for the treatment of house dust mite allergic rhinitis in Canada: an alternative to minimize treatment costs?

“…Practice guidelines recommend a standardized dosing approach for SCIT flexibility to individual needs as acknowledged [6, 9, 13]. This flexibility was recently demonstrated in US and Canadian practice where a wide variety in SCIT treatment regimens for AR was being used [15]. Therefore, depending on the specific patient’s needs and also the preferences for titration dosing schedule of the administering physician, it is possible that some patients would receive slightly more or fewer titration doses upon treatment initiation.…”

“…As SLIT-tablets are a relatively novel approach to AIT in Canada [9], SCIT is more commonly used. In North America, as opposed to Europe, it is more common to combine more than one allergen into the same SCIT injection [15]. Important to note in this context is, that efficacy of the SQ HDM SLIT-tablet in a North American field trial was shown to be effective and well tolerated in subjects with HDM allergy, most of whom (76%) were polysensitized to allergens other than HDM, and efficacy in HDM-monosensitized and polysensitized subjects was comparable [26].…”

“…[15])–––24–––––24–– GP (Ontario 20%, Quebec 95%) a –––4.8–––––22.8–– Specialist (Ontario 80%, Quebec 5%) a –––19.2–––––1.2––Maintenance visits (4 weeks between inj. [15])–––71313–––71313 GP (95%) a –––6.6512.3512.35–––6.6512.3512.35 Specialist (5%) a –––0.350.650.65–––0.350.650.65Nurse time ([h]; Ontario 0.5 per inj., Quebec 0.75 per inj.) a –––15.56.56.5–…”

“… GP general practitioner, HDM SCIT house dust mite subcutaneous immunotherapy, inj. injection, SQ HDM SLIT-tablet SQ house dust mite sublingual immunotherapy tablet a Based on physician input, b Patient’s time include: travel time round trip 40 min [15], wait time 15 min [15], injection time 4 min a , post-injection time 30 min [15], physician consultation time 20 min a , c Patient’s time include: Travel time round trip 40 min [15], wait time 15 min [15], physician consultation time 20 min a , and for year 1 only a 30 min post-tablet observational time after first tablet intake [28]…”

“…For HDM SCIT it was assumed that 24 weekly injections would be given for the titration phase, followed by maintenance injections once every 4 weeks. It was also assumed that one 10 mL vial would last for 10 injections based on findings by Blume et al [15]. The key difference between these treatments is the at-home administration of the SQ HDM SLIT-tablet resulting in reduced use of services of health care professionals as well as lower costs due to a decline in work productivity.…”