Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Int Forum Allergy Rhinol. 2023 May;13(5):924-941. doi: 10.1002/alr.23086. Epub 2022 Sep 21.
Sublingual immunotherapy (SLIT) adherence in the literature is often evaluated in closely monitored trials that may impact patient behavior; real-world SLIT adherence is relatively unknown. This systematic review intends to assess SLIT adherence in studies that reflect real-world settings.
A literature search of PubMed, Embase, Cochrane, Web of Science, and Scopus for real-world studies examining SLIT adherence was performed. Monitored clinical trials were excluded. Paired investigators independently reviewed all articles. For this review, "persistence" was defined as continuing therapy and not being lost to follow-up and "adherence" as persistence in accordance with prescribed SLIT dose, dosing schedule, and duration. Article quality was assessed using a modified Newcastle-Ottawa scale and then converted to AHRQ standards (good, fair, and poor).
The search yielded 1596 nonduplicate abstracts, from which 32 articles (n = 63,683 patients) met criteria. Twenty-six (81%) studies reported persistence rates ranging from 7.0% to 88.7%, and 18 (56%) reported adherence rates ranging from 9.6% to 97.0%. Twenty-one (66%) studies surveyed reasons for discontinuing SLIT. All studies were Oxford level of evidence 2b and of good (n = 12) to fair (n = 20) quality.
Reported rates of real-world SLIT persistence and adherence varied widely by study methodology (e.g., follow-up duration, objective vs. subjective assessment). Studies with longer follow-up generally reported lower rates; 3-year persistence ranged from 7% to 59.0% and 3-year adherence from 9.6% to 49.0%. Future studies of SLIT adherence would benefit from following concordant definitions of persistence/adherence and standardized reporting metrics.
舌下免疫疗法（SLIT）的依从性在文献中经常通过密切监测的试验来评估，这些试验可能会影响患者的行为；而真实世界中的 SLIT 依从性则相对未知。本系统评价旨在评估反映真实世界环境的研究中 SLIT 的依从性。
对 PubMed、Embase、Cochrane、Web of Science 和 Scopus 中的真实世界研究进行了 SLIT 依从性的文献检索。排除了监测临床试验。由两名研究人员独立审查所有文章。在本综述中，“持续性”定义为继续治疗且未失访，“依从性”则定义为按照规定的 SLIT 剂量、给药方案和持续时间进行治疗的持续性。使用改良的 Newcastle-Ottawa 量表评估文章质量，然后转换为 AHRQ 标准（好、中、差）。
检索共得到 1596 篇非重复摘要，其中 32 篇文章（n=63683 名患者）符合纳入标准。26 篇（81%）研究报告了持续性率，范围为 7.0%至 88.7%，18 篇（56%）报告了依从性率，范围为 9.6%至 97.0%。21 篇（66%）研究调查了停止 SLIT 的原因。所有研究均为牛津证据水平 2b 级，质量为好（n=12）至中（n=20）。
真实世界中 SLIT 持续性和依从性的报告率因研究方法（如随访时间、客观评估与主观评估）而异。随访时间较长的研究报告的比率通常较低；3 年持续性率范围为 7%至 59.0%，3 年依从率范围为 9.6%至 49.0%。未来关于 SLIT 依从性的研究将受益于遵循一致性的持续性/依从性定义和标准化的报告指标。
