Comparison of rhinitis treatments using MASK-air® data and considering the minimal important difference
Bernardo Sousa-Pinto 1 2 3, Holger J Schünemann 4, Ana Sá-Sousa 1 2 3, Rafael José Vieira 1 2 3, Rita Amaral 1 2 3, Josep M Anto 5 6 7 8, Ludger Klimek 9, Wienczyslawa Czarlewski 10, Joaquim Mullol 11, Oliver Pfaar 12, Anna Bedbrook 13, Luisa Brussino 14, Violeta Kvedariene 15, Desirée Larenas-Linnemann 16, Yoshitaka Okamoto 17, Maria Teresa Ventura 18, Ioana Agache 19, Ignacio J Ansotegui 20, Karl C Bergmann 21 22, Sinthia Bosnic-Anticevich 23, Jan Brozek 4, G Walter Canonica 24 25, Victoria Cardona 26, Pedro Carreiro-Martins 27 28, Thomas Casale 29, Lorenzo Cecchi 30, Tomas Chivato 31, Derek K Chu 32, Cemal Cingi 33, Elísio M Costa 34, Alvaro A Cruz 35, Stefano Del Giacco 36, Philippe Devillier 37, Patrik Eklund 38, Wytske J Fokkens 39, Bilun Gemicioglu 40, Tari Haahtela 41, Juan Carlos Ivancevich 42, Zhanat Ispayeva 43, Marek Jutel 44 45, Piotr Kuna 46, Igor Kaidashev 47, Musa Khaitov 48, Helga Kraxner 49, Daniel Laune 50, Brian Lipworth 51, Renaud Louis 52, Michael Makris 53, Riccardo Monti 54, Mario Morais-Almeida 55, Ralph Mösges 56, Marek Niedoszytko 57, Nikolaos G Papadopoulos 58, Vincenzo Patella 59, Nhân Pham-Thi 60, Frederico S Regateiro 61, Sietze Reitsma 62, Philip W Rouadi 63 64, Boleslaw Samolinski 65, Aziz Sheikh 66, Milan Sova 67, Ana Todo-Bom 68, Luis Taborda-Barata 69 70 71, Sanna Toppila-Salmi 41, Joaquin Sastre 72, Ioanna Tsiligianni 73, Arunas Valiulis 74, Olivier Vandenplas 75, Dana Wallace 76, Susan Waserman 77, Arzu Yorgancioglu 78, Mihaela Zidarn 79 80, Torsten Zuberbier 21 22, Joao A Fonseca 1 2 3, Jean Bousquet 21 22 81
Affiliations
Affiliations
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.
- RISE - Health Research Network, University of Porto, Porto, Portugal.
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada.
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, and Center for Rhinology and Allergology, Wiesbaden, Germany.
- Medical Consulting Czarlewski, Levallois, France.
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain.
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
- ARIA, Montpellier, France.
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy.
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University and Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
- Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan.
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy.
- Transylvania University Brasov, Brasov, Romania.
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, and Sydney Local Health District, Sydney, NSW, Australia.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain.
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
- NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal.
- Division of Allergy/Immunology, University of South Florida, Tampa, Florida, USA.
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
- School of Medicine, University CEU San Pablo, Madrid, Spain.
- Department of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
- ENT Department, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey.
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal.
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Brazil.
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy.
- VIM Suresnes, UMR_0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France.
- Department of Computing Science, Umeå University, Umeå, Sweden.
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Location AMC, Amsterdam, The Netherlands.
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
- President of Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan.
- Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland.
- ALL-MED Medical Research Institute, Wrocław, Poland.
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
- Poltava State Medical University, Poltava, Ukraine.
- National Research Center, Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular Immunology, Moscow, Russia and Pirogov Russian National Research Medical University, Moscow, Russia.
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
- KYomed INNOV, Montpellier, France.
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK.
- Department of Pulmonary Medicine, CHU Sart-Tilman, and GIGA I3 Research Group, Liege, Belgium.
- Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
- Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
- IMSB, Medical Faculty, University at Cologne, and ClinCompetence Cologne GmbH, Cologne, Germany.
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland.
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
- Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Italy.
- Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France.
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra and Institute of Immunology, Faculty of Medicine, University of Coimbra, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands.
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
- ENT Department, Dar Al Shifa Hospital- Salmiya, Salmiya, Kuwait.
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland.
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
- Department of Pulmonary Medicine and Tuberculosis, University Hospital Brno, Brno, Czech Republic.
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
- UBIAir - Clinical & Experimental Lung Centre, University of Beira Interior, Covilhã, Portugal.
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.
- Fundacion Jimenez Diaz, CIBERES, Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain.
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece and International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland.
- Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania.
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
- Nova Southeastern University, Fort Lauderdale, Florida, USA.
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada.
- Celal Bayar University, Department of Pulmonology, Manisa, Turkey.
- University Clinic of Respiratory and Allergic Diseases, Golnick, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
- University Hospital Montpellier, Montpellier, France.
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/