Comparison of rhinitis treatments using MASK‐air® data and considering the minimal important difference

Abstract

Background Different treatments exist for allergic rhinitis (AR), including pharmacotherapy and allergen immunotherapy (AIT), but they have not been compared using direct patient data (i.e., “real‐world data”). We aimed to compare AR pharmacological treatments on (i) daily symptoms, (ii) frequency of use in co‐medication, (iii) visual analogue scales (VASs) on allergy symptom control considering the minimal important difference (MID) and (iv) the effect of AIT. Methods We assessed the MASK‐air® app data (May 2015–December 2020) by users self‐reporting AR (16–90 years). We compared eight AR medication schemes on reported VAS of allergy symptoms, clustering data by the patient and controlling for confounding factors. We compared (i) allergy symptoms between patients with and without AIT and (ii) different drug classes used in co‐medication. Results We analysed 269,837 days from 10,860 users. Most days (52.7%) involved medication use. Median VAS levels were significantly higher in co‐medication than in monotherapy (including the fixed combination azelastine‐fluticasone) schemes. In adjusted models, azelastine‐fluticasone was associated with lower average VAS global allergy symptoms than all other medication schemes, while the contrary was observed for oral corticosteroids. AIT was associated with a decrease in allergy symptoms in some medication schemes. A difference larger than the MID compared to no treatment was observed for oral steroids. Azelastine‐fluticasone was the drug class with the lowest chance of being used in co‐medication (adjusted OR = 0.75; 95% CI = 0.71–0.80). Conclusion Median VAS levels were higher in co‐medication than in monotherapy. Patients with more severe symptoms report a higher treatment, which is currently not reflected in guidelines.

Digitally‐enabled, patient‐centred care in rhinitis and asthma multimorbidity: The ARIA‐MASK‐air®approach

“…In several papers, the same results were observed: comedication is associated with worse control by comparison to monotherapy with INCS or Aze-Flu. 40,58,62,68 Days with the best control were those with no medication. The same results were observed during and outside the pollen season.…”

Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study

“…In addition, this approach avoids an over-representation of observations provided on the rst day of MASK-air use, which tend to be associated with worse reported symptoms than all other days. 28 This approach also addresses potential biases associated with low MASK-air reporting. Although each included participant reported an average of 82 MASK-air days, participants not providing data in at least 3 dierent months reported an average of only 5 days.…”

“…11 This study followed the Consensusbased Standards for the selection of health Measurement Instruments (COSMIN) and the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis recommen dations. 12 The protocol of this study is available in the appendix (pp [21][22][23][24][25][26][27][28][29].…”

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA‐MeDALL hypothesis

“…162 Moreover, they more often reported a treatment with intranasal corticosteroids, and oral antihistamines were associated with poor control. 163 In MASK-air, a co-medication pattern was associated with a poorer rhinitis control than in monotherapy. 164,165 In the combined symptom-medication score, the distinction between rhinitis and A + R was clear, with large effect sizes (submitted).…”

“…In the French general population epidemiologic study Constances, participants with A + R had more severe symptoms than those with rhinitis alone 162 . Moreover, they more often reported a treatment with intranasal corticosteroids, and oral antihistamines were associated with poor control 163 . In MASK‐air, a co‐medication pattern was associated with a poorer rhinitis control than in monotherapy 164,165 .…”