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

Abstract

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.

Allergen immunotherapy in people, dogs, cats and horses – differences, similarities and research needs

“…These adverse effects are seen both in adults and in children and are more common with SCIT than with SLIT (Table ) and with native allergens than allergoids . The extended treatment times of AIT until clinical improvement, explained by the need to change an ongoing immune response, result in low patient compliance and high dropout rates of both SCIT and SLIT . Protocols for SCIT include classical (time‐consuming) or abbreviated rush regimens.…”

“…Different protocols and dosages are found on the market. Compared to SCIT, SLIT has been associated with a decreased compliance, possibly due to the necessary daily administration . Meta‐analyses and reviews demonstrate a well‐documented efficacy for SLIT in particular for pollen and house dust mite allergens in patients suffering from allergic rhinitis .…”

Allergen Immunotherapy: Efficacy, Persistence, Consistency, and Cost Effectiveness

“…Of those who start AIT, a high percentage are non-adherent to the recommended treatment schedule, often discontinuing therapy before completion of the recommended 3 to 5 years needed to achieve sustained clinical benefit [36][37][38]. It is estimated that of the 24 million adults in the US with AR, 10 million are candidates for AIT, but only 3.5 million initiate AIT and up between 11% to 97% discontinue therapy before reaching 3 years of therapy [39][40][41][42][43][44][45][46][47].…”

“…The most meaningful studies are those that compare SCIT and SLIT head-to-head in the same research protocol. Nine studies, comparing persistence of SCIT to that of SLIT for a minimum of three years, published 2001-2018 were reviewed [39][40][41][42][43][44][45][46][47]. A total of 105,302 patients were included in these 9 studies [SCIT:96,297; SLIT8913:8913: Local nasal immunotherapy (LNIT), 82].…”

<p>Interactive Network Platform Improves Compliance and Efficacy of Subcutaneous Immunotherapy for Patients with Allergic Rhinitis</p>

“…7 Lemberg et al analysed the compliance of 207 SCIT patients at private allergy centres in Germany and found that the overall drop-out rate was 32.4% over the 3-year treatment period, and the first year of the treatment period was considered a high-risk period during which patients usually chose to quit. 8 The consequences of noncompliance are concerning because noncompliance can tremendously affect the effectiveness of SCIT and lead to more medical expenses for patients. 7,9 Achieving adequate symptom control is pivotal to the success of AR management and the main expectation of patients.…”