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Real-World Adherence and Evidence of Subcutaneous and Sublingual Immunotherapy in Grass and Tree Pollen-Induced Allergic Rhinitis and Asthma

Authors Vogelberg C, Brüggenjürgen B, Richter H, Jutel M

Received 19 December 2019

Accepted for publication 14 April 2020

Published 13 May 2020 Volume 2020:14 Pages 817—827


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Christian Vogelberg,1 Bernd Brüggenjürgen,2 Hartmut Richter,3 Marek Jutel4,5

1Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany; 2Institute for Health Economics, Steinbeis University Berlin, Berlin, Germany; 3Epidemiology, IQVIA, Frankfurt am Main, Germany; 4All-MED Medical Research Institute, Warsaw, Poland; 5Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland

Correspondence: Christian Vogelberg
University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, Dresden 01307, Germany
Tel +49 351 458-5699
Fax +49 351 458-4334

Purpose: Allergen immunotherapy (AIT), when continued for 3 years, is the only disease-modifying treatment for AR and asthma. Adherence is a key to ensure effectiveness, and poor adherence is a contraindication for AIT. The objective of this study was to evaluate real-world adherence to AIT with subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) preparations in patients allergic to grass or tree pollen. The impact of AIT on the consumption of asthma and rhinitis medication was also analyzed.
Patients and Methods: In this retrospective cohort analysis of a German longitudinal prescription database, the adherence of a grass and tree pollen allergoid was examined and compared to two sublingual AIT tablets/drops. Patients receiving grass or tree allergen-specific immunotherapy prescriptions were compared with non-AIT patients receiving symptomatic allergic rhinitis (AR) and asthma prescriptions. The study endpoints included therapy adherence, AR progression, and asthma progression. Multivariate regression analyses were used to estimate the effects of SCIT or SLIT, adjusting for variables related to demographics and prescriptions.
Results: SCIT adherence was 60.1– 61.8% at 2 years and 35.0– 37.5% at 3 years for the two allergens. SLIT adherence was distinctly lower (29.5– 36.5% and 9.6– 18.2%, respectively). Adherence in children was higher compared to adolescents or adults. All products were highly efficacious at reducing symptomatic AR medication consumption. SCIT also reduced asthma medication use for both allergens, whereas for SLIT these results were significant only for grasses but not trees.
Conclusion: Subcutaneous AIT in a real-world setting achieved significantly higher adherence rates compared to sublingual administration. SCIT reduced the use of rhinitis and asthma medication significantly for both allergens, while SLIT reduced the use of rhinitis medication for both allergens and the use of asthma medication for grasses only.

Keywords: adherence, real-world evidence, allergic rhinitis, asthma, grass pollen, tree pollen, subcutaneous immunotherapy, sublingual immunotherapy

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