Network Meta-analysis Shows Commercialized Subcutaneous and Sublingual Grass Products Have Comparable Efficacy

Nelson, Harold S.; Cartier, Shannon; Allen‐Ramey, Felicia; Lawton, Simon; Calderón, Moisés A.

doi:10.1016/j.jaip.2014.09.018

Cited by 82 publications

(70 citation statements)

References 55 publications

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“…| 783 the placebo group), would allow us to improve our comparative estimates between products. 221 This would allow product-specific recommendations to be made. The different local regulations 47 and availability of products 48 makes this difficult at a European level.…”

Section: Summary Gaps In the Evide Nce And Future Perspectivesmentioning

confidence: 99%

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Roberts

Pfaar

Akdiş

et al. 2017

Allergy

564

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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Section: Summary Gaps In the Evide Nce And Future Perspectivesmentioning

confidence: 99%

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Roberts

Pfaar

Akdiş

et al. 2017

Allergy

564

705

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“…In a double‐blinded, randomized placebo‐controlled trial (RCT) in patients with allergic rhinoconjunctivitis, GP‐SLIT treatment was also found to induce a significant and durable induction of neutralizing antibody responses as well as decreased symptom score up to 2 years after completion of a 3‐year treatment period . Moreover, a recent meta‐analysis comparing SLIT tablets, SLIT drops, and SCIT injections for GP allergies reported comparable reduction in symptom scores and supplemental medication use for SLIT tablets and SCIT injections …”

Section: Introductionmentioning

confidence: 99%

“…Moreover, SCIT, but not SLIT, treatment induced suppression of IL‐5 production by CD4 + T cells . While an initial meta‐analysis reported that SCIT was more effective in symptom control and reduction in medication, a more recent study provided indirect evidence that SCIT and SLIT have a similar efficacy for the treatment of allergy . Patients have been reported to show a preference for SLIT over SCIT …”

Section: Introductionmentioning

confidence: 99%

Subcutaneous immunotherapy suppresses Th2 inflammation and induces neutralizing antibodies, but sublingual immunotherapy suppresses airway hyperresponsiveness in grass pollen mouse models for allergic asthma

Hesse

Brouwer

Petersen

et al. 2018

Clin Experimental Allergy

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In conclusion, GP-SCIT suppresses Th2 inflammation and induced neutralizing antibodies, while GP-SLIT suppresses the clinically relevant lung function parameters in an asthma mouse model, indicating that the two application routes depend on partially divergent mechanisms of tolerance induction. Interestingly, these data mirror observations in clinical studies, underscoring the translational value of these mouse models.

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“…In Europe, the sublingual route is approved for allergy immunotherapy while the subcutaneous route is approved in the USA [5]. While the efficacies of these two routes have rarely been compared directly, a recent meta-analysis indicates that tablets designed to treat grass pollen allergy and subcutaneous delivery of pollen antigens can each reduce symptoms of rhinoconjunctivitis to a similar extent [11 ]. Delivery of antigen can also be increased by either direct injection into lymph nodes with the aid of ultrasound or by binding the antigen to particular adjuvants such as aluminium hydroxide [7,12].…”

Section: Allergymentioning

confidence: 99%

Antigen-based immunotherapy (AIT) for autoimmune and allergic disease

MacLeod

Anderton

2015

Current Opinion in Pharmacology

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Autoimmune and allergic diseases are major causes of morbidity. Antigen-based immunotherapy (AIT) is immunologically the most satisfying means of specifically targeting only those T cells driving disease, thereby inducing antigen-specific immune tolerance, with the lowest adverse risk profile. AIT is highly effective in rodent models of T cell-driven inflammation and is now in clinical trials. The range of approaches to applying AIT in the clinic prevents a consensus on the molecular basis for this form of tolerance. In particular, there has been a paucity of information on how pre-activated effector and memory T cells respond to AIT. New, advanced murine models of AIT are beginning to deliver such information at the cellular, biochemical, transcriptional and epigenetic levels.

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Network Meta-analysis Shows Commercialized Subcutaneous and Sublingual Grass Products Have Comparable Efficacy

Cited by 82 publications

References 55 publications

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Subcutaneous immunotherapy suppresses Th2 inflammation and induces neutralizing antibodies, but sublingual immunotherapy suppresses airway hyperresponsiveness in grass pollen mouse models for allergic asthma

Antigen-based immunotherapy (AIT) for autoimmune and allergic disease

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