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

Abstract

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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“…It is known that SCIT is related to a higher number of systemic adverse reactions, with a risk of fatal or near-fatal reaction being minimal but not absent [ 29 ]. Although SLIT application causes systemic side effects in only 1% of cases, an earlier and higher dropout has been reported in patients treated with SLIT than in the ones treated with SCIT [ 27 ]. This may be caused by a higher rate of milder but discomforting side effects (approximately 80–90%) especially during the first weeks, such as oral mucosal pruritus (particularly in patients with pollen–food syndrome), mild swelling of the tongue or gastric discomfort (e.g., vomiting, abdominal pain and diarrhea) [ 29 ].…”

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“…These unmet needs refer to improved patient selection and improved outcomes based on biomarkers and preventive potential, issues related to the long-term effects of AIT, availability of products and/or obstacles for the indication of AIT. Typically, fewer than 7% of patients within the indication for AIT in a population start on AIT ( 19 ) and fewer than 30% complete a three-year treatment ( 20 ). It has been proposed that a survey is needed to evaluate the long-term effects of AIT in patients who have received it more than a decade ago to assess longevity of benefit.…”