Allergy immunotherapy prescribing trends for grass pollen-induced allergic rhinitis in Germany: a retrospective cohort analysis

Abstract

BackgroundAllergy immunotherapy is an effective treatment for patients with allergic rhinitis whose symptoms are unresolved with pharmacotherapy. Allergy immunotherapy for grass pollen-induced allergic rhinitis is available in three modalities: subcutaneous immunotherapy and sublingual immunotherapy as a tablet or drop. This study aimed to understand trends in allergy immunotherapy prescribing and practice patterns for grass allergies in adult and paediatric patients in Germany.MethodsA retrospective cohort study was conducted using IMS Disease Analyzer in Germany. Patients with an allergy immunotherapy prescription for grass pollen (Anatomical Therapeutic Chemical [ATC] classification code V01AA02) from September 2005 to December 2012 were included in the study. General Practitioners (GPs), dermatologists, Ear, Nose and Throat (ENT)-specialists, paediatricians and pneumologists were included as the allergy immunotherapy prescribing physicians in the study. Descriptive analyses were conducted on patient characteristics at index and prescribing physician specialty; a test for trend was conducted for timing of initiation of first allergy immunotherapy prescription in each annual prescribing season.ResultsEighteen thousand eight hundred fifty eligible patients were identified during the study period. The majority of patients received subcutaneous immunotherapy; however, the proportion of patients receiving sublingual immunotherapy tablets increased from 8 % in 2006/2007 to 29 % in 2011/2012 (p < 0.001). Initiation of subcutaneous immunotherapy and Oralair® generally peaked during each prescribing year in two seasons (September-October and January) while GRAZAX® prescriptions peaked in autumn (September-October). ENT-specialists and dermatologists were the largest allergy immunotherapy prescribers in adults, while paediatricians and ENT-specialists were the largest prescribers of allergy immunotherapy in paediatric patients.ConclusionsSubcutaneous immunotherapy remained the dominant allergy immunotherapy modality for grass pollen-induced allergic rhinitis in Germany for adult and paediatric patients; however, there was a marked increase in proportion of patients receiving sublingual immunotherapy tablets from 2006/2007 to 2011/2012, after their introduction to the market in 2006. ENT-specialists, dermatologists and paediatricians were responsible for the majority of prescribing. The predominance of particular modalities within certain physician specialties likely reflects different treatment goals or needs.

How does the efficacy and safety of Oralair&reg; compare to other products on the market?

“…Also, they are less common and less severe when treatment is restarted before the next pollen season, with precoseasonal Oralair ® . 9 In the Oralair ® trials, no use of epinephrine has been documented. In trials with Grazax ® /Grastek ® , an epinephrine autoinjector was used in two patients because of adverse reactions, judged to be probably tablet-related.…”

“…This trend was clearly shown by McDonell et al who conducted a retrospective cohort study using IMS ® Disease Analyzer (IMS HEALTH GmbH& Co. OHG [IMS], Frankfurt am Main, Germany) in Germany over a 7-year period (September 2005 – December 2012). 9 Data from 18,850 patients with a prescription for grass pollen AIT were analyzed. Although the majority of the patients still received SC-AIT, there was a statistically significant tendency for a rise in the SL-AIT prescription rate, from 8% during 2006/2007 to 29% during 2011/2012.…”

“…Although the majority of the patients still received SC-AIT, there was a statistically significant tendency for a rise in the SL-AIT prescription rate, from 8% during 2006/2007 to 29% during 2011/2012. 9 Also in the USA a rise in SL-AIT prescription tendency was detected, even though the absolute percentage of patients that are prescribed SL-AIT versus SC-AIT is still low 10 and can be expected to have risen after the Food and Drug Administration (FDA) approval of SLIT tablets in 2014.…”

Allergy immunotherapies for allergic rhinitis: systematic review and assessment of evolving quality

“…In European countries, subcutaneous immunotherapy (SCIT) has been available for more than a century (12). Sublingual immunotherapy (SLIT), which is available in drop formulation and, more recently, in tablet formulation, was first licensed in 2006 (13). There are limitations in the evidence base for SCIT and SLIT products.…”

A survey on the perception of allergy specialists about the reimbursed grass pollen tablets for seasonal allergic rhinitis in Italy

“…Sublingual immunotherapy (SLIT) is a feasible option to classical subcutaneous immunotherapy (SCIT), that has its main advantages over SCIT in a better safety and in a lower cost [ 2 , 3 ]. Actually, SLIT is increasingly prescribed also in countries where SCIT has been dominant, such as Germany [ 4 ] and is the most used form of AIT in Italy [ 5 ]. The allowance of allergen extracts for AIT by the different regional health systems in Italy is uneven, and in a study that evaluated the factors influencing the AIT prescription by a questionnaire submitted to about 450 specialists, the cost of treatment and the reimbursement were listed among the factors possibly influencing the prescription [ 6 ].…”