Treatment effect of sublingual immunotherapy tablets and pharmacotherapies for seasonal and perennial allergic rhinitis: Pooled analyses

Stephen R. Durham, Peter Socrates Creticos, Harold S. Nelson, Ziliang Li, Amarjot Kaur, Eli O. Meltzer, Hendrik Nolte

Research output: Contribution to journalArticle

Abstract

Background Data comparing the treatment effect of allergy immunotherapy and pharmacotherapy are lacking. Objective We sought to indirectly compare the treatment effect of sublingual immunotherapy (SLIT)-tablets with pharmacotherapy for seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). Methods Pooled data from randomized, double-blind, placebo-controlled trials for the clinical development programs of selected allergic rhinitis treatments were evaluated. Total nasal symptom scores (TNSSs) relative to placebo were compared. Subjects scored symptoms daily during entire pollen seasons in 6 timothy grass SLIT-tablet trials (n = 3094) and 2 ragweed SLIT-tablet trials (n = 658) and during the last 8 weeks of treatment in 2 house dust mite (HDM) SLIT-tablet trials (n = 1768). Subjects scored symptoms daily in 7 montelukast (10 mg, n = 6799), 9 desloratadine (5 mg, n = 4455), and 8 mometasone furoate nasal spray (MFNS; 200 μg daily, n = 2140) SAR or PAR trials. SLIT-tablet trials allowed rescue medication use, whereas most pharmacotherapy trials did not. A fixed-effect meta-analysis method estimated differences in on-treatment average TNSSs. Results In grass and ragweed SLIT-tablet trials, overall improvement in TNSSs relative to placebo was 16.3% and 17.1%, respectively. In HDM SLIT-tablet trials, TNSS overall improvement relative to placebo was 16.1%. In the montelukast, desloratadine, and MFNS trials, TNSS overall improvement relative to placebo was 5.4%, 8.5%, and 22.2%, respectively, for SAR trials, and 3.7%, 4.8%, and 11.2%, respectively, for PAR trials. Conclusions Although comparisons were limited by study design heterogeneity and use of rescue medications in SLIT-tablet trials, effects on nasal symptoms with timothy grass and ragweed SLIT-tablets were nearly as great as with MFNS and numerically greater than with montelukast and desloratadine for SAR. HDM SLIT-tablet effects were numerically greater than all pharmacotherapies for PAR. SLIT-tablets offer the additional benefit of long-term efficacy.

Original languageEnglish (US)
Pages (from-to)1081-1088.e4
JournalJournal of Allergy and Clinical Immunology
Volume138
Issue number4
DOIs
StatePublished - Oct 1 2016

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Sublingual Immunotherapy
Seasonal Allergic Rhinitis
Tablets
Drug Therapy
montelukast
Rhinitis, Allergic, Perennial
Nose
Ambrosia
Pyroglyphidae
Placebos
Phleum
Therapeutics
Mometasone Furoate
Nasal Sprays
Controlled Clinical Trials
Pollen
Poaceae
Immunotherapy
Meta-Analysis
Hypersensitivity

Keywords

  • Allergen immunotherapy
  • allergic rhinoconjunctivitis
  • antihistamine
  • grass
  • house dust mite
  • intranasal corticosteroid
  • leukotriene receptor antagonists
  • meta-analysis
  • ragweed
  • sublingual immunotherapy tablet

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Treatment effect of sublingual immunotherapy tablets and pharmacotherapies for seasonal and perennial allergic rhinitis : Pooled analyses. / Durham, Stephen R.; Creticos, Peter Socrates; Nelson, Harold S.; Li, Ziliang; Kaur, Amarjot; Meltzer, Eli O.; Nolte, Hendrik.

In: Journal of Allergy and Clinical Immunology, Vol. 138, No. 4, 01.10.2016, p. 1081-1088.e4.

Research output: Contribution to journalArticle

Durham, Stephen R. ; Creticos, Peter Socrates ; Nelson, Harold S. ; Li, Ziliang ; Kaur, Amarjot ; Meltzer, Eli O. ; Nolte, Hendrik. / Treatment effect of sublingual immunotherapy tablets and pharmacotherapies for seasonal and perennial allergic rhinitis : Pooled analyses. In: Journal of Allergy and Clinical Immunology. 2016 ; Vol. 138, No. 4. pp. 1081-1088.e4.
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abstract = "Background Data comparing the treatment effect of allergy immunotherapy and pharmacotherapy are lacking. Objective We sought to indirectly compare the treatment effect of sublingual immunotherapy (SLIT)-tablets with pharmacotherapy for seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). Methods Pooled data from randomized, double-blind, placebo-controlled trials for the clinical development programs of selected allergic rhinitis treatments were evaluated. Total nasal symptom scores (TNSSs) relative to placebo were compared. Subjects scored symptoms daily during entire pollen seasons in 6 timothy grass SLIT-tablet trials (n = 3094) and 2 ragweed SLIT-tablet trials (n = 658) and during the last 8 weeks of treatment in 2 house dust mite (HDM) SLIT-tablet trials (n = 1768). Subjects scored symptoms daily in 7 montelukast (10 mg, n = 6799), 9 desloratadine (5 mg, n = 4455), and 8 mometasone furoate nasal spray (MFNS; 200 μg daily, n = 2140) SAR or PAR trials. SLIT-tablet trials allowed rescue medication use, whereas most pharmacotherapy trials did not. A fixed-effect meta-analysis method estimated differences in on-treatment average TNSSs. Results In grass and ragweed SLIT-tablet trials, overall improvement in TNSSs relative to placebo was 16.3{\%} and 17.1{\%}, respectively. In HDM SLIT-tablet trials, TNSS overall improvement relative to placebo was 16.1{\%}. In the montelukast, desloratadine, and MFNS trials, TNSS overall improvement relative to placebo was 5.4{\%}, 8.5{\%}, and 22.2{\%}, respectively, for SAR trials, and 3.7{\%}, 4.8{\%}, and 11.2{\%}, respectively, for PAR trials. Conclusions Although comparisons were limited by study design heterogeneity and use of rescue medications in SLIT-tablet trials, effects on nasal symptoms with timothy grass and ragweed SLIT-tablets were nearly as great as with MFNS and numerically greater than with montelukast and desloratadine for SAR. HDM SLIT-tablet effects were numerically greater than all pharmacotherapies for PAR. SLIT-tablets offer the additional benefit of long-term efficacy.",
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AU - Li, Ziliang

AU - Kaur, Amarjot

AU - Meltzer, Eli O.

AU - Nolte, Hendrik

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N2 - Background Data comparing the treatment effect of allergy immunotherapy and pharmacotherapy are lacking. Objective We sought to indirectly compare the treatment effect of sublingual immunotherapy (SLIT)-tablets with pharmacotherapy for seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). Methods Pooled data from randomized, double-blind, placebo-controlled trials for the clinical development programs of selected allergic rhinitis treatments were evaluated. Total nasal symptom scores (TNSSs) relative to placebo were compared. Subjects scored symptoms daily during entire pollen seasons in 6 timothy grass SLIT-tablet trials (n = 3094) and 2 ragweed SLIT-tablet trials (n = 658) and during the last 8 weeks of treatment in 2 house dust mite (HDM) SLIT-tablet trials (n = 1768). Subjects scored symptoms daily in 7 montelukast (10 mg, n = 6799), 9 desloratadine (5 mg, n = 4455), and 8 mometasone furoate nasal spray (MFNS; 200 μg daily, n = 2140) SAR or PAR trials. SLIT-tablet trials allowed rescue medication use, whereas most pharmacotherapy trials did not. A fixed-effect meta-analysis method estimated differences in on-treatment average TNSSs. Results In grass and ragweed SLIT-tablet trials, overall improvement in TNSSs relative to placebo was 16.3% and 17.1%, respectively. In HDM SLIT-tablet trials, TNSS overall improvement relative to placebo was 16.1%. In the montelukast, desloratadine, and MFNS trials, TNSS overall improvement relative to placebo was 5.4%, 8.5%, and 22.2%, respectively, for SAR trials, and 3.7%, 4.8%, and 11.2%, respectively, for PAR trials. Conclusions Although comparisons were limited by study design heterogeneity and use of rescue medications in SLIT-tablet trials, effects on nasal symptoms with timothy grass and ragweed SLIT-tablets were nearly as great as with MFNS and numerically greater than with montelukast and desloratadine for SAR. HDM SLIT-tablet effects were numerically greater than all pharmacotherapies for PAR. SLIT-tablets offer the additional benefit of long-term efficacy.

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KW - meta-analysis

KW - ragweed

KW - sublingual immunotherapy tablet

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