过敏原免疫疗法对桦树花粉相关过敏性鼻炎及哮喘在真实世界中的优势
2019/09/09
摘要
背景：关于过敏原免疫疗法（皮下/舌下免疫疗法（SCIT / SLIT））的益处，来自真实世界的证据较少，其是过敏性鼻炎（AR）唯一具有长期疗效的疾病调节干预措施。这项来自真实世界的研究评估了桦树花粉相关性过敏性鼻炎和/或哮喘患者中6种过敏原免疫疗法（天然花粉SLIT / SCIT，四种类变应原SCITs）与缓解症状药物使用对AR症状及哮喘症状/发作的影响。
方法：在这项来自德国纵向处方数据库的回顾性队列研究中，AIT患者接受了≥2个连续季节性治疗周期; 非AIT患者在三个季节期间或上个月有≥3个关于AR的处方。患者匹配：具体年份，年龄，性别，具体年份的主要症状，治疗期间季节性治疗周期数，基线AR /哮喘治疗处方。多元回归分析比较AIT和非AIT组中的处方数据作为临床状态/疾病进展的代表。
结果：随访6年，AIT（65.4％）与非AIT（47.4％）患者相比，AR药物明显增多; 比值比（OR）[95％置信区间（CI）]：0.51 [（0.48-0.54）; P <0.001]（协变量调整后减少28.6％vs非AIT; P <0.001），AIT（49.1％）与非AIT（35.1％）患者相比未使用哮喘控制药物明显升高[OR（95％CI）：0.59（0.55-0.65）; P <0.001]（与非AIT相比减少32％; P <0.001），或当前哮喘控制药物使用减少（32％协变量调整减少与非AIT相比; P <0.001）。在治疗期间，AIT与非AIT组相比新发哮喘风险显着降低（OR：0.83; P = 0.001）。
结论：桦树花粉免疫疗法在治疗停止后长达6年的随访期间，在显着降低过敏性鼻炎及哮喘患者药物摄入量方面，显示出其在真实世界的优势，并显著降低了新发哮喘使用药物治疗的风险。
Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma.
Wahn U, Bachert C, Heinrich J, Richter H, Zielen S.
Abstract
BACKGROUND: Real-world evidence is sparse on the benefits of allergen immunotherapy [AIT; subcutaneous/sublingual immunotherapy(SCIT/SLIT)], the only disease-modifying intervention for allergic rhinitis (AR) with long-term efficacy. This real-life study evaluated the effect of six AITs (native pollen SLIT/SCIT, four allergoid SCITs) vs symptomatic medication use, on AR symptoms and asthma symptoms/onset, in patients with birch pollen-associated AR and/or asthma.
METHODS: In this retrospective cohort analysis of a German longitudinal prescription database, AIT patients received ≥2 successive seasonal treatment cycles; non-AIT patients had ≥3 AR prescriptions in three seasons or previous month. Patients were matched for: index year, age, gender, main indication at index, number of seasonal cycles within treatment period, baseline AR/asthma treatment prescriptions. Multiple regression analysis compared prescription data in AIT and non-AIT groups as proxy for clinical status/disease progression.
RESULTS: Up to 6 years of follow-up, significantly more AIT (65.4%) vs non-AIT (47.4%) patients were AR medication-free; odds ratio (OR) [95% confidence interval (CI)]: 0.51 [(0.48-0.54); P < 0.001] (28.6% covariate-adjusted reduction vs non-AIT; P < 0.001), and significantly more AIT (49.1%) vs non-AIT (35.1%) patients were asthma medication-free [OR (95% CI): 0.59 (0.55-0.65); P < 0.001] (32% reduction vs non-AIT; P < 0.001), or reduced existing asthma medication use (32% covariate-adjusted reduction vs non-AIT; P < 0.001). During treatment, new-onset asthma risk was significantly reduced in the AIT vs non-AIT group (OR: 0.83; P = 0.001).
CONCLUSIONS: Birch pollen AIT demonstrated real-world benefits up to 6 years post-treatment cessation through significantly reduced AR and asthma medication intake, and significantly decreased risk of new-onset asthma medication use on-treatment.
背景：关于过敏原免疫疗法（皮下/舌下免疫疗法（SCIT / SLIT））的益处，来自真实世界的证据较少，其是过敏性鼻炎（AR）唯一具有长期疗效的疾病调节干预措施。这项来自真实世界的研究评估了桦树花粉相关性过敏性鼻炎和/或哮喘患者中6种过敏原免疫疗法（天然花粉SLIT / SCIT，四种类变应原SCITs）与缓解症状药物使用对AR症状及哮喘症状/发作的影响。
方法：在这项来自德国纵向处方数据库的回顾性队列研究中，AIT患者接受了≥2个连续季节性治疗周期; 非AIT患者在三个季节期间或上个月有≥3个关于AR的处方。患者匹配：具体年份，年龄，性别，具体年份的主要症状，治疗期间季节性治疗周期数，基线AR /哮喘治疗处方。多元回归分析比较AIT和非AIT组中的处方数据作为临床状态/疾病进展的代表。
结果：随访6年，AIT（65.4％）与非AIT（47.4％）患者相比，AR药物明显增多; 比值比（OR）[95％置信区间（CI）]：0.51 [（0.48-0.54）; P <0.001]（协变量调整后减少28.6％vs非AIT; P <0.001），AIT（49.1％）与非AIT（35.1％）患者相比未使用哮喘控制药物明显升高[OR（95％CI）：0.59（0.55-0.65）; P <0.001]（与非AIT相比减少32％; P <0.001），或当前哮喘控制药物使用减少（32％协变量调整减少与非AIT相比; P <0.001）。在治疗期间，AIT与非AIT组相比新发哮喘风险显着降低（OR：0.83; P = 0.001）。
结论：桦树花粉免疫疗法在治疗停止后长达6年的随访期间，在显着降低过敏性鼻炎及哮喘患者药物摄入量方面，显示出其在真实世界的优势，并显著降低了新发哮喘使用药物治疗的风险。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Allergy. 2019 Mar;74(3):594-604. doi: 10.1111/all.13598. Epub 2018 Oct 10.）
（Allergy. 2019 Mar;74(3):594-604. doi: 10.1111/all.13598. Epub 2018 Oct 10.）
Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma.
Wahn U, Bachert C, Heinrich J, Richter H, Zielen S.
Abstract
BACKGROUND: Real-world evidence is sparse on the benefits of allergen immunotherapy [AIT; subcutaneous/sublingual immunotherapy(SCIT/SLIT)], the only disease-modifying intervention for allergic rhinitis (AR) with long-term efficacy. This real-life study evaluated the effect of six AITs (native pollen SLIT/SCIT, four allergoid SCITs) vs symptomatic medication use, on AR symptoms and asthma symptoms/onset, in patients with birch pollen-associated AR and/or asthma.
METHODS: In this retrospective cohort analysis of a German longitudinal prescription database, AIT patients received ≥2 successive seasonal treatment cycles; non-AIT patients had ≥3 AR prescriptions in three seasons or previous month. Patients were matched for: index year, age, gender, main indication at index, number of seasonal cycles within treatment period, baseline AR/asthma treatment prescriptions. Multiple regression analysis compared prescription data in AIT and non-AIT groups as proxy for clinical status/disease progression.
RESULTS: Up to 6 years of follow-up, significantly more AIT (65.4%) vs non-AIT (47.4%) patients were AR medication-free; odds ratio (OR) [95% confidence interval (CI)]: 0.51 [(0.48-0.54); P < 0.001] (28.6% covariate-adjusted reduction vs non-AIT; P < 0.001), and significantly more AIT (49.1%) vs non-AIT (35.1%) patients were asthma medication-free [OR (95% CI): 0.59 (0.55-0.65); P < 0.001] (32% reduction vs non-AIT; P < 0.001), or reduced existing asthma medication use (32% covariate-adjusted reduction vs non-AIT; P < 0.001). During treatment, new-onset asthma risk was significantly reduced in the AIT vs non-AIT group (OR: 0.83; P = 0.001).
CONCLUSIONS: Birch pollen AIT demonstrated real-world benefits up to 6 years post-treatment cessation through significantly reduced AR and asthma medication intake, and significantly decreased risk of new-onset asthma medication use on-treatment.
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