Need for longitudinal studies to assess the real-world effectiveness of allergy immunotherapy in patients with allergic rhinitis and asthma – Authors´ reply

Fritzsching, Benedikt; Contoli, Marco; Porsbjerg, Celeste; Buchs, Sarah; Larsen, John; Elliott, Lisa; Romano, M.; Freemantle, Nick

doi:10.1016/j.lanepe.2022.100388

Cited by 4 publications

(19 citation statements)

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“…The last result is likely related to GBM AIT referrals and prescribing, and is compatible with the German REACT-study finding that subjects treated with AIT were seen more frequently by specialists during the first 3–5 follow-up years, than non-treated in the prescription database. [3, 15, 17]…”

Section: Discussionmentioning

confidence: 99%

“…The last result is likely related to GBM AIT referrals and prescribing, and is compatible with the German REACTstudy finding that subjects treated with AIT were seen more frequently by specialists during the first 3-5 follow-up years, than non-treated in the prescription database. [3,15,17] Limitations A limitation of the study was the lack of data on clinical diagnosis of AR and sensitisation status. However, to identify those suffering from AR we restricted our analysis to individuals using INS, which is the classic common effective and specific medication prescribed for AR.…”

Section: Strengthsmentioning

confidence: 99%

“…In clinical trials, longer follow-up is restricted by resources and patient compliance, [11][12][13][14] whereas longitudinal observational studies are more feasible and can therefore add unique and valuable information about long term effects of AIT. [3,[6][7][8][9][10][15][16][17] Follow-up times up to 15 years after end of therapy have not been studied yet. Using prescription and register data since 1994 for the entire country of Denmark, we therefore studied effectiveness on AR medication use up to 15 years after end of 3 years treatment (18 years of follow-up) in a large, unselected, national patient population treated with GBM AIT, comparing with well-matched controls and also avoiding exclusions e.g.…”

Section: Introductionmentioning

confidence: 99%

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The effectiveness of grass, birch, and mugwort pollen allergen immunotherapy over 18 years: A national cohort study in Denmark

Bager

Poulsen

Wohlfahrt

et al. 2022

Preprint

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Background Long-term effectiveness of pollen allergen immune therapy (AIT) for allergic rhinitis (AR) has been studied for different durations. We studied effectiveness over 18 years using nationwide register-data for Denmark. Methods A register-based cohort study using data on filled prescriptions, 1995-2018, Denmark. In a cohort of 1.1 million intranasal corticosteroid spray users (proxy for AR), we matched users treated with grass, birch or mugwort (GBM) AIT 1:2 with non-treated users on baseline year and 24 characteristics in the 3 years prior to baseline. The primary outcome was the odds ratio (OR) of using anti-allergic nasal spray during the pollen season in the treated vs. non-treated group modelled in a logistic generalized estimating equations analysis using an autoregressive correlation structure and adjusted for years since baseline (one year categories). Results Among 7,914 AR patients treated with GBM AIT, the OR of using nasal spray 0-5 years after baseline was reduced when compared with 15,520 non-treated AR individuals (0-2 years, odds ratio (OR) 0.81(0.76-0.85); 3-5 years, OR 0.82(0.77-0.87)), but was close to unity or higher thereafter (6-9 years, OR 0.96(0.91-1.03); 10-18 years, OR 1.15(1.06-1.24). In post-hoc analyses, results were more consistent for those who already had 3 of 3 baseline years of use (0-2 years, OR 0.59 (0.54-0.64); 3-5 years, OR 0.64 (0.59-0.71); 6-9 years, 0.82 (0.75-0.91); 10-18 years, 0.95 (0.84-1.08), and in patients using nasal spray in the last pollen season (0-2 years, OR 0.76 (0.72-0.80); 3-5 years 0.84 (0.78-0.91); 6-9 years, OR 0.94 (0.86-1.03); 10-18 years, 0.90 (0.81-1.00)) as opposed to patients who did not use nasal spray in the last pollen season. The post-hoc findings were likewise more consistent for eye drop and oral antihistamine users (secondary outcomes). Conclusion Patients treated with GBM AIT in routine care to a higher degree stopped using anti-allergic nasal spray 0-5 years after starting the standard three years of therapy. Post-hoc analyses suggested results were more consistent among patients with persistent AR.

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Section: Discussionmentioning

confidence: 99%

Section: Strengthsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effectiveness of grass, birch, and mugwort pollen allergen immunotherapy over 18 years: A national cohort study in Denmark

Bager

Poulsen

Wohlfahrt

et al. 2022

Preprint

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“…The REACT study (NCT04125888) was a retrospective cohort study that evaluated claims data from a German health insurance database [Betriebkrankenkasse (BKK)], which included data for approximately 5.9 million individuals (47). The REACT study methodology and findings have been published separately (47,48). Briefly, anonymized insurance claims data for the study period (1 January 2007 to 31 December 2017) were reviewed, and subjects with a confirmed diagnosis of AR according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) criteria (with or without asthma) were identified for evaluation (47).…”

Section: Methodsmentioning

confidence: 99%

“…The recently published REAl-world effeCtiveness in allergy immunoTherapy (REACT) study was a large, retrospective, and propensity score matched cohort study conducted in Germany, which demonstrated the real-world, long-term effectiveness of AIT for the treatment of AR and asthma in subjects with prescriptions for AIT vs. matched AR controls without AIT prescriptions (47). Before matching, the overall AIT group of subjects was found to be younger, with more atopic comorbidities and a greater drug burden, compared to those with a diagnosis of AR who did not have prescriptions for AIT indicating that, in real-life clinical practice, AIT is mainly offered to AR subjects who already have a substantial burden of disease (47).…”

Section: Introductionmentioning

confidence: 99%

High baseline prevalence of atopic comorbidities and medication use in children treated with allergy immunotherapy in the REAl-world effeCtiveness in allergy immunoTherapy (REACT) study

Fritszching¹,

Porsbjerg²,

Buchs³

et al. 2023

Front. Pediatr.

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BackgroundRespiratory allergy, commonly manifesting as allergic rhinitis (AR) and asthma, is a chronic progressive disease that frequently starts in childhood. Allergy immunotherapy (AIT) is the only causal treatment for respiratory allergy with the potential to modify the underlying cause of allergy and, ultimately, prevent disease progression. This analysis aimed to determine if AIT is received sufficiently early to halt the progression of allergic disease, by characterizing the burden and progression of disease in children prior to AIT initiation in real-life clinical practice.MethodsThe REAl-world effeCtiveness in allergy immunoTherapy (REACT) study was a large retrospective cohort study using German claims data between 2007 and 2017. Characteristics of two pre-defined AIT age cohorts from the REACT study – children (aged <18 years) and adults (aged ≥18 years) – were evaluated during the 1-year period before the first AIT prescription. For comparison, a control group of all subjects with a confirmed diagnosis of AR and without prescriptions for AIT was included. Burden of disease was assessed using diagnostic codes for atopic comorbidities [e.g., atopic dermatitis (AD), asthma, and acute allergic conjunctivitis] and non-atopic comorbidities (e.g., migraine, headache); medication use, recorded as prescriptions for symptom-relieving AR medication and reliever/controller medication for asthma, was also assessed. Data were analyzed descriptively, using summary statistics.ResultsBoth children (n = 11,036) and adults (n = 30,037) showed a higher prevalence of atopic comorbidities and a greater drug burden prior to AIT initiation compared to AR patients not treated with AIT (n = 1,003,332). In the two age-specific AIT cohorts, children consistently showed the highest prevalence of atopic comorbidities compared to adults (AIT children, AIT adults – asthma: 41.4%, 34.5%; AD: 19.9%, 10.2%; acute allergic conjunctivitis: 13.6%, 10.2%). Generally, prescriptions per year for symptom-relieving AR and asthma treatments were also higher for children initiating AIT vs. adults (AIT children, AIT adults – AR prescriptions per subject: 1.72, 0.73; asthma prescriptions per subject: 1.42, 0.79).ConclusionsChildren with AR who are offered AIT in real-life show considerable disease burden prior to initiation. As AIT may alleviate the burden and halt the progression of allergic disease, considering AIT earlier in the disease course may be warranted.

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The effectiveness of pollen allergen immunotherapy on allergic rhinitis over 18 years: A national cohort study in Denmark

Bager,

Poulsen,

Wohlfahrt

et al. 2024

Allergy

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BackgroundBecause long‐term effectiveness of pollen allergen immune therapy (AIT) for allergic rhinitis (AR) is not well‐described, we studied effectiveness over 18 years in Denmark.MethodsA register‐based cohort study using data on filled prescriptions, 1995–2016, Denmark. In a cohort of 1.1 million intranasal corticosteroid inhaler users (proxy for AR), we matched users treated with grass, birch or mugwort AIT 1:2 with non‐treated users on baseline year and 24 characteristics in the 3 years prior to baseline. The primary outcome was the odds ratio (OR) of using anti‐allergic nasal inhaler during the pollen season in the treated versus non‐treated group by years since baseline.ResultsAmong 7760 AR patients treated with pollen AIT, the OR of using nasal inhaler 0–5 years after baseline was reduced when compared with 15,520 non‐treated AR individuals (0–2 years, OR 0.84 (0.81–0.88); 3–5 years, OR 0.88 (0.84–0.92)), but was close to unity or higher thereafter (6–9 years, OR 1.03 (0.97–1.08); 10–18 years, OR 1.18 (1.11–1.26)). In post hoc analyses, results were more consistent for those who already had 3 of 3 baseline years of use, and in patients using nasal inhaler in the latest pollen season (0–2 years, OR 0.76 (0.72–0.79); 3–5 years OR 0.86 (0.81–0.93); 6–9 years, OR 0.94 (0.87–1.02); 10–18 years, OR 0.94 (0.86–1.04)) as opposed to no such use.ConclusionsPatients treated with pollen AIT in routine care to a higher degree stopped using anti‐allergic nasal inhaler 0–5 years after starting the standard 3 years of therapy, and not beyond 5 years. Post hoc analyses suggested effectiveness was more consistent among patients with persistent AR.

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Need for longitudinal studies to assess the real-world effectiveness of allergy immunotherapy in patients with allergic rhinitis and asthma – Authors´ reply

Cited by 4 publications

References 4 publications

The effectiveness of grass, birch, and mugwort pollen allergen immunotherapy over 18 years: A national cohort study in Denmark

The effectiveness of grass, birch, and mugwort pollen allergen immunotherapy over 18 years: A national cohort study in Denmark

High baseline prevalence of atopic comorbidities and medication use in children treated with allergy immunotherapy in the REAl-world effeCtiveness in allergy immunoTherapy (REACT) study

The effectiveness of pollen allergen immunotherapy on allergic rhinitis over 18 years: A national cohort study in Denmark

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