Pfaar Oliver, Richter Hartmut, Sager Angelika, Miller Christoph, Müller Thomas, Jutel Marek
Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, Philipps-Universität Marburg, University Hospital Marburg, Marburg, Germany.
Epidemiology, IQVIA, Frankfurt, Germany.
Clin Transl Allergy. 2023 May;13(5):e12245. doi: 10.1002/clt2.12245.
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.
IQVIA 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.
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%.
Persistence in AIT in AR was low in this retrospective prescription-based database and was clearly linked to patient age and application route.
变应性鼻炎（AR）是一种在发达国家患病率不断上升的广泛疾病。唯一能解决根本病因的治疗方法是变应原免疫疗法（AIT）。这种治疗通过两种给药途径进行，即皮下免疫疗法（SCIT）或舌下免疫疗法（SLIT）。然而，在超过3年的漫长治疗过程中坚持治疗是这种治疗方案疗效的关键。依从性受损会对公共卫生资源产生重大影响。本研究的目的是评估两种给药途径的AIT治疗的持续性。
使用IQVIA LRx识别2009年至2018年间开始接受AIT治疗的对草花粉（GP）、早花树花粉（EFTP）和屋尘螨（HDM）变应原过敏的患者。患者按AIT组（皮下脱色聚合变应原AIT [dSCIT]、其他皮下AIT [oSCIT]和SLIT）和年龄（5 - 11岁、12 - 17岁、18岁及以上）在每个变应原类别中进行分类。此外，对他们进行长达3年的随访，直至治疗停止。3年后仍在接受治疗的患者被视为失访。生成持续性的Kaplan-Meier曲线，并通过对数秩检验进行比较。
纳入的三种变应原类别患者数量分别为38717例GP、23183例EFTP和41728例HDM AIT。在所有变应原类别和任何产品组中，患者的持续性随年龄组增加而降低，5 - 11岁与12 - 17岁之间的差异大于12 - 17岁与18岁及以上之间的差异。完成AIT第一年治疗的患者百分比很低，特别是对于SLIT，12个月后仍坚持治疗的患者为22.2% - 27.1%。dSCIT的相应数字为52.0% - 64.1%，oSCIT为38.3% - 50.3%。
在这个基于回顾性处方的数据库中，AR患者接受AIT治疗的持续性较低，并且明显与患者年龄和给药途径有关。
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