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

Bernardo Sousa-Pinto 1 2 3Holger J Schünemann 4Ana Sá-Sousa 1 2 3Rafael José Vieira 1 2 3Rita Amaral 1 2 3Josep M Anto 5 6 7 8Ludger Klimek 9Wienczyslawa Czarlewski 10Joaquim Mullol 11Oliver Pfaar 12Anna Bedbrook 13Luisa Brussino 14Violeta Kvedariene 15Desirée Larenas-Linnemann 16Yoshitaka Okamoto 17Maria Teresa Ventura 18Ioana Agache 19Ignacio J Ansotegui 20Karl C Bergmann 21 22Sinthia Bosnic-Anticevich 23Jan Brozek 4G Walter Canonica 24 25Victoria Cardona 26Pedro Carreiro-Martins 27 28Thomas Casale 29Lorenzo Cecchi 30Tomas Chivato 31Derek K Chu 32Cemal Cingi 33Elísio M Costa 34Alvaro A Cruz 35Stefano Del Giacco 36Philippe Devillier 37Patrik Eklund 38Wytske J Fokkens 39Bilun Gemicioglu 40Tari Haahtela 41Juan Carlos Ivancevich 42Zhanat Ispayeva 43Marek Jutel 44 45Piotr Kuna 46Igor Kaidashev 47Musa Khaitov 48Helga Kraxner 49Daniel Laune 50Brian Lipworth 51Renaud Louis 52Michael Makris 53Riccardo Monti 54Mario Morais-Almeida 55Ralph Mösges 56Marek Niedoszytko 57Nikolaos G Papadopoulos 58Vincenzo Patella 59Nhân Pham-Thi 60Frederico S Regateiro 61Sietze Reitsma 62Philip W Rouadi 63 64Boleslaw Samolinski 65Aziz Sheikh 66Milan Sova 67Ana Todo-Bom 68Luis Taborda-Barata 69 70 71Sanna Toppila-Salmi 41Joaquin Sastre 72Ioanna Tsiligianni 73Arunas Valiulis 74Olivier Vandenplas 75Dana Wallace 76Susan Waserman 77Arzu Yorgancioglu 78Mihaela Zidarn 79 80Torsten Zuberbier 21 22Joao A Fonseca 1 2 3Jean Bousquet 21 22 81

Affiliations

14 May 2022

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doi: 10.1111/all.15371


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.

Keywords: allergen immunotherapy; allergic rhinitis; co-medication; multivariable mixed-effects model; real-world data.


References

https://pubmed.ncbi.nlm.nih.gov/