Immunotherapy compliance: comparison of subcutaneous versus sublingual immunotherapy

Leader, Brittany A.; Rotella, Melissa; Stillman, Leisa; DelGaudio, John M.; Patel, Zara M.; Wise, Sarah K.

doi:10.1002/alr.21699

Cited by 33 publications

(37 citation statements)

References 21 publications

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“…One must consider that their results were obtained using a specific definition of compliance based on a rating scale of compliance from poor, fair, good to excellent. That circumstance makes it rather difficult to compare their results to those of the studies depicted in Table 4 18…”

Section: Discussionmentioning

confidence: 99%

Sublingual versus subcutaneous immunotherapy: patient adherence at a large German allergy center

Lemberg¹,

Berk²,

Shah‐Hosseini³

et al. 2017

PPA

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BackgroundMany placebo-controlled studies have demonstrated that allergen immunotherapy (AIT) is an effective therapy for treating allergies. Both commonly used routes, subcutaneous (SCIT) and sublingual immunotherapy (SLIT), require high patient adherence to be successful. In the literature, numbers describing adherence vary widely; this investigation compares these two routes of therapy directly.MethodsAll data were retrieved from the patient data management system of a center for dermatology, specific allergology, and environmental medicine in Germany. All 330 patients (aged 13–89 years) included in this study had commenced AIT between 2003 and 2011, thus allowing a full 3-year AIT cycle to be considered for each investigated patient.ResultsIn this specific center, SCIT was prescribed to 62.7% and SLIT to 37.3% of all included patients. The total dropout rate of the whole patient cohort was 34.8%. Overall, SLIT patients showed a higher dropout rate (39.0%) than did SCIT patients (32.4%); however, the difference between these groups was not significant. Also, no significant difference between the overall dropout rates for men and for women was observed. A Kaplan–Meier curve of the patient collective showed a remarkably high dropout rate for the first year of therapy.ConclusionThe analysis presented in this single-center study shows that most patients who discontinue AIT do so during the first year of therapy. Patients seem likely to finish the 3-year therapy cycle if they manage to adhere to treatment throughout the first year. Strategies for preventing nonadherence in AIT, therefore, need to be developed and standardized in future investigations.

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Section: Discussionmentioning

confidence: 99%

Sublingual versus subcutaneous immunotherapy: patient adherence at a large German allergy center

Lemberg¹,

Berk²,

Shah‐Hosseini³

et al. 2017

PPA

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“…[163][164][165][166][167][168][169] are key (Grade C). 169 One randomized study suggests that adherence is much better with 3-monthly follow-up appointments compared to 6 or 12-monthly follow-up (Grade B).…”

Section: Adherencementioning

confidence: 99%

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Roberts

Pfaar

Akdiş

et al. 2017

Allergy

561

705

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drawn on data from a systematic review of the literature, more recent published studies and multistakeholder expert clinical opinion. This Guideline is aimed at healthcare professionals who are encouraged to take the recommendations into account in the context of delivering clinical care. This Guideline is not a substitute for professional clinical judgment, which professionals need to exercise in the context of delivering personalised healthcare. AbstractAllergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side-effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease-modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project "EAACI Guidelines on Allergen Immunotherapy." It aims to provide evidence-based clinical recommendations and has been informed by a formal systematic review and meta-analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach.The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product-specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short-term benefit. The strongest evidence for long-term benefit is documented for grass AIT (especially for the grass 766 | ROBERTS, PFAAR ET AL. tablets) where long-term benefit is seen. To achieve long-term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long-term benefit and use in children. | ME TH ODOLOGYThis Guideline was produced using the Appraisal of Guidelines forResearch & Evaluation (AGREE II) approach, 17,18 a structured approach to guideline production (see Table S1). This is designed to ensure appropriate representation of the full range of stakeholders, a careful search for and critical appraisal of the relevant literature, a systematic approach to the formulation and presentation of recommendations and steps to ensure that the risk of bias is minimized at each step of the process. The process started on April 2015 beginning with detailed face-to-face discussions agreeing on the process and the key clinical areas to address, followed by face-to-face meetings, and regular web conferences in which professional and lay representatives participated. | Clarifying the scope and purpose of the guidelinesThe scope of this EAACI Guideline is multifaceted...

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“…Up to 50% of patients suffering from chronic diseases do not follow treatment recommendations . Recent studies report patients undergoing subcutaneous immunotherapy (SCIT) have nonadherence rates between 11% and 50%, patient adherence with AIT is even poorer in observational studies compared to controlled studies and it diminishes over time with treatment . Kiel et al .…”

mentioning

confidence: 99%

Risk factors and strategies in nonadherence with subcutaneous immunotherapy: a real‐life study

Yang

et al. 2018

Int Forum Allergy Rhinol

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Immunotherapy compliance: comparison of subcutaneous versus sublingual immunotherapy

Abstract: The results of this study showed higher rates of patient adherence to treatment protocols among SCIT patients. There was no decrease in SCIT compliance rates across treatment stages.

Cited by 33 publications

References 21 publications

Sublingual versus subcutaneous immunotherapy: patient adherence at a large German allergy center

Sublingual versus subcutaneous immunotherapy: patient adherence at a large German allergy center

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Risk factors and strategies in nonadherence with subcutaneous immunotherapy: a real‐life study

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