Sublingual immunotherapy persistence and adherence in real‐world settings: A systematic review

Abstract

Background 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. Methods 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). Results 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. Conclusion 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.

House dust mite sublingual allergen immunotherapy tablet is safe and well-tolerated in Dutch clinical practice

“…In real life, patients often do not fill out their prescriptions as advised, while AIT treatment needs to be persisted for 3 years ( 23 , 35 ). In the past, major issues were reported with SLIT drops compliance in the Netherlands ( 36 ).…”

“…Moreover, data from the Danish prescription register showed a compliance rate of 53% and 57% for SLIT-tablet and SCIT, respectively, after 3-years treatment ( 29 ). Furthermore, compliance in a recent Dutch grass pollen SLIT-tablet study was 76% ( 43 ) Possible explanations for the observed differences include: increased attention on compliance, the definition of compliance, different study populations, and differences in SLIT type (drops vs. tablets) ( 35 ). Daily intake of tablets may be cumbersome in the beginning but after a period of time, in particular doing it in a routine way, e.g., before diner, it becomes a habit and less of a burden ( 26 , 38 ).…”

“…Ways to improve compliance include more patient visits and selecting patients dedicated to persisting treatment ( 35 , 39 ). For example compliance in clinical trials is generally higher than in real-life studies ( 40 ).…”

“…For example compliance in clinical trials is generally higher than in real-life studies ( 40 ). In addition, solid patient education on SLIT-tablet treatment may help ( 35 , 39 ). Part of patient education may be reassuring patients, that AEs will decrease over time as validated by this study ( 35 , 39 ).…”

Internet follow-up can improve the compliance of sublingual immunotherapy in children with allergic rhinitis: a retrospective cohort study

“…A systematic review of SLIT compliance showed that the reported real-world SLIT persistence and compliance rates vary greatly due to research methods, and studies with long follow-up periods usually report low compliance rates ( 12 ). The main endpoint of this study was the compliance of SLIT patients.…”