使用MASK-air®数据并考虑最小重要差异的鼻炎治疗方法比较

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

作者信息

Sousa-Pinto Bernardo, Schünemann Holger J, Sá-Sousa Ana, Vieira Rafael José, Amaral Rita, Anto Josep M, Klimek Ludger, Czarlewski Wienczyslawa, Mullol Joaquim, Pfaar Oliver, Bedbrook Anna, Brussino Luisa, Kvedariene Violeta, Larenas-Linnemann Desirée, Okamoto Yoshitaka, Ventura Maria Teresa, Agache Ioana, Ansotegui Ignacio J, Bergmann Karl C, Bosnic-Anticevich Sinthia, Brozek Jan, Canonica G Walter, Cardona Victoria, Carreiro-Martins Pedro, Casale Thomas, Cecchi Lorenzo, Chivato Tomas, Chu Derek K, Cingi Cemal, Costa Elísio M, Cruz Alvaro A, Del Giacco Stefano, Devillier Philippe, Eklund Patrik, Fokkens Wytske J, Gemicioglu Bilun, Haahtela Tari, Ivancevich Juan Carlos, Ispayeva Zhanat, Jutel Marek, Kuna Piotr, Kaidashev Igor, Khaitov Musa, Kraxner Helga, Laune Daniel, Lipworth Brian, Louis Renaud, Makris Michael, Monti Riccardo, Morais-Almeida Mario, Mösges Ralph, Niedoszytko Marek, Papadopoulos Nikolaos G, Patella Vincenzo, Pham-Thi Nhân, Regateiro Frederico S, Reitsma Sietze, Rouadi Philip W, Samolinski Boleslaw, Sheikh Aziz, Sova Milan, Todo-Bom Ana, Taborda-Barata Luis, Toppila-Salmi Sanna, Sastre Joaquin, Tsiligianni Ioanna, Valiulis Arunas, Vandenplas Olivier, Wallace Dana, Waserman Susan, Yorgancioglu Arzu, Zidarn Mihaela, Zuberbier Torsten, Fonseca Joao A, Bousquet Jean

机构信息

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.

CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.

出版信息

Allergy. 2022 Oct;77(10):3002-3014. doi: 10.1111/all.15371. Epub 2022 Jun 13.

DOI:10.1111/all.15371

PMID:35567393

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.

摘要

背景

变应性鼻炎（AR）有多种治疗方法，包括药物治疗和变应原免疫治疗（AIT），但尚未使用直接患者数据（即“真实世界数据”）进行比较。我们旨在比较AR药物治疗在以下方面的效果：（i）每日症状，（ii）联合用药的使用频率，（iii）考虑最小重要差异（MID）的变应性症状控制视觉模拟量表（VAS），以及（iv）AIT的效果。

方法

我们通过用户自我报告AR（16 - 90岁）评估了MASK-air®应用程序数据（2015年5月 - 2020年12月）。我们比较了八种AR药物治疗方案在报告的变应性症状VAS上的差异，按患者对数据进行聚类，并控制混杂因素。我们比较了（i）接受和未接受AIT的患者之间的变应性症状，以及（ii）联合用药中使用的不同药物类别。

结果

我们分析了10860名用户的269837天数据。大多数日子（52.7%）涉及药物使用。联合用药时VAS的中位数水平显著高于单药治疗（包括固定复方氮卓斯汀 - 氟替卡松）方案。在调整模型中，与所有其他药物治疗方案相比，氮卓斯汀 - 氟替卡松与更低的平均VAS总体变应性症状相关，而口服糖皮质激素则相反。在某些药物治疗方案中，AIT与变应性症状的减轻相关。与未治疗相比，口服类固醇观察到大于MID的差异。氮卓斯汀 - 氟替卡松是联合用药可能性最低的药物类别（调整后的OR = 0.75；95%CI = 0.71 - 0.80）。