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Comparison of rhinitis treatments using MASK-air® data and considering the minimal important difference

  • Bernardo Sousa-Pinto
  • , Holger J. Schünemann
  • , Ana Sá-Sousa
  • , Rafael José Vieira
  • , Rita Amaral
  • , Josep M. Anto
  • , Ludger Klimek
  • , Wienczyslawa Czarlewski
  • , Joaquim Mullol
  • , Oliver Pfaar
  • , Anna Bedbrook
  • , Luisa Brussino
  • , Violeta Kvedariene
  • , Desirée Larenas-Linnemann
  • , Yoshitaka Okamoto
  • , Maria Teresa Ventura
  • , Ioana Agache
  • , Ignacio J. Ansotegui
  • , Karl C. Bergmann
  • , Sinthia Bosnic-Anticevich
  • Jan Brozek, G. Walter Canonica, Victoria Cardona, Pedro Carreiro-Martins, Thomas Casale, Lorenzo Cecchi, Tomas Chivato, Derek K. Chu, Cemal Cingi, Elísio M. Costa, Alvaro A. Cruz, Stefano del Giacco, Philippe Devillier, Patrik Eklund, Wytske J. Fokkens, Bilun Gemicioglu, Tari Haahtela, Juan Carlos Ivancevich, Zhanat Ispayeva, Marek Jutel, Piotr Kuna, Igor Kaidashev, Musa Khaitov, Helga Kraxner, Daniel Laune, Brian Lipworth, Renaud Louis, Michael Makris, Riccardo Monti, Mario Morais-Almeida, Ralph Mösges, Marek Niedoszytko, Nikolaos G. Papadopoulos, Vincenzo Patella, Nhân Pham-Thi, Frederico S. Regateiro, Sietze Reitsma, Philip W. Rouadi, Boleslaw Samolinski, Aziz Sheikh, Milan Sova, Ana Todo-Bom, Luis Taborda-Barata, Sanna Toppila-Salmi, Joaquin Sastre, Ioanna Tsiligianni, Arunas Valiulis, Olivier Vandenplas, Dana Wallace, Susan Waserman, Arzu Yorgancioglu, Mihaela Zidarn, Torsten Zuberbier, Joao A. Fonseca, Jean Bousquet*
*Corresponding author for this work
  • University of Porto
  • McMaster University
  • Barcelona Institute for Global Health
  • Pompeu Fabra University
  • CIBER - Center for Biomedical Research Network
  • Johannes Gutenberg University Mainz
  • Conseil médical Czarlewski, Levallois, France
  • University of Barcelona
  • University of Marburg
  • ARIA
  • University of Turin
  • Vilnius University
  • Médica Sur Clinical Foundation and Hospital
  • Chiba University
  • University of Bari
  • Transilvania University of Brasov
  • Department of Allergy and Immunology, Erandio, Spain
  • Charité – Universitätsmedizin Berlin
  • Fraunhofer Institute for Translational Medicine and Pharmacology ITMP
  • The University of Sydney
  • Humanitas University
  • IRCCS Istituto Clinico Humanitas - Rozzano (Milano)
  • Autonomous University of Barcelona
  • University of Lisbon
  • NOVA University Lisbon
  • University of South Florida
  • SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
  • CEU Universities
  • Osmangazi University
  • Universidade Federal da Bahia
  • University Hospital of Cagliari
  • Université Paris-Saclay
  • Umeå University
  • Istanbul University - Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, 34320, Turkey
  • Hospital District of Helsinki and Uusimaa
  • IServicio de Alergia e Immunologia, Argentina
  • Kazakh National Medical University
  • Wrocław Medical University
  • Medical University of Łódź
  • Ukrainina Medical Stomatological Academy, Poltava, Ukraine
  • Russian Ministry of Health
  • Semmelweis University
  • KYomed INNOV
  • University of Dundee
  • University of Liege
  • National and Kapodistrian University of Athens
  • Fondazione Policlinico Universitario Agostino Gemelli IRCCS
  • Hospital CUF-Descobertas
  • Center for Biochemistry, Faculty of Medicine, University of Cologne, Cologne, Germany
  • Medical University of Gdańsk
  • Department of Medicine, Division of Allergy and Clinical Immunology, Agency of Health ASL Salerno, “Santa Maria della Speranza” Hospital, Battipaglia, Salerno, Italy
  • Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
  • University of Coimbra
  • Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
  • Dar Al-Shifa Hospital
  • Medical University of Warsaw
  • University of Edinburgh
  • Masaryk University
  • University of Beira Interior
  • Department of Immunoallergology, Covilhã, Portugal
  • Universidad Autónoma de Madrid
  • University of Crete
  • Department of Medical Oncology, UCLouvain and University of Botswana, CHU Ucl Namur, Belgium
  • Nova Southeastern University
  • Manisa Celal Bayar University
  • University Clinic of Respiratory and Allergic Diseases
  • University of Ljubljana
  • Lapeyronie - CHU of Montpellier, France

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: Different treatments exist for allergic rhinitis (AR), including pharmacotherapy and allergen immunotherapy (AIT), but they have not been compared using direct patient data (i.e., “real-world data”). We aimed to compare AR pharmacological treatments on (i) daily symptoms, (ii) frequency of use in co-medication, (iii) visual analogue scales (VASs) on allergy symptom control considering the minimal important difference (MID) and (iv) the effect of AIT. Methods: We assessed the MASK-air® app data (May 2015–December 2020) by users self-reporting AR (16–90 years). We compared eight AR medication schemes on reported VAS of allergy symptoms, clustering data by the patient and controlling for confounding factors. We compared (i) allergy symptoms between patients with and without AIT and (ii) different drug classes used in co-medication. Results: We analysed 269,837 days from 10,860 users. Most days (52.7%) involved medication use. Median VAS levels were significantly higher in co-medication than in monotherapy (including the fixed combination azelastine-fluticasone) schemes. In adjusted models, azelastine-fluticasone was associated with lower average VAS global allergy symptoms than all other medication schemes, while the contrary was observed for oral corticosteroids. AIT was associated with a decrease in allergy symptoms in some medication schemes. A difference larger than the MID compared to no treatment was observed for oral steroids. Azelastine-fluticasone was the drug class with the lowest chance of being used in co-medication (adjusted OR = 0.75; 95% CI = 0.71–0.80). Conclusion: Median VAS levels were higher in co-medication than in monotherapy. Patients with more severe symptoms report a higher treatment, which is currently not reflected in guidelines.
Original languageEnglish
Pages (from-to)3002-3014
Number of pages13
JournalAllergy: European Journal of Allergy and Clinical Immunology
Volume77
Issue number10
Early online date2022
DOIs
Publication statusPublished - Oct 2022

Keywords

  • allergen immunotherapy
  • allergic rhinitis
  • co-medication
  • multivariable mixed-effects model
  • real-world data

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