作者
Bernardo Sousa-Pinto,Holger J. Schünemann,Ana Sá-Sousa,Rafael Felipe da Costa Vieira,Rita Goreti Amaral,Josep M. Antó,Ludger Klimek,Wienczyslawa Czarlewski,Joaquim Mullol,Oliver Pfaar,Jean Bousquet,Luisa Brussino,Violeta Kvedariene,Désirée Larenas-Linnemann,Yoshitaka Okamoto,Maria Teresa Ventura,Ioana Agache,Ignacio J. Ansotegui,Karl E. Bergmann,Sinthia Bosnic-Anticevich,Jan Brozek,Giorgio Walter Canonica,Victoria Cardona,Pedro Carreiro-Martins,Thomas B. Casale,Lorenzo Cecchi,Tomas Chivato,Derek K. Chu,Cemal Cingi,Elísio Costa,Alvaro A. Cruz,Stefano Del Giacco,Philippe Devillier,Patrik Eklund,Wytske Fokkens,Bilun Gemicioglu,Tari Haahtela,Juan Carlos Ivancevich,Zhanat Ispayeva,Marek Jutel,Piotr Kuna,Igor Kaidashev,Musa Khaitov,Helga Kraxner,Daniel Laune,Brian J. Lipworth,Renaud Louis,Michael Makris,Riccardo Monti,Mário Morais-Almeida,Ralph Mösges,Marek Niedoszytko,Nikolaos G. Papadopoulos,Vincenzo Patella,Nhân Pham-Thi,Frederico S. Regateiro,Sietze Reitsma,Philip W. Rouadi,Bolesław Samoliński,Aziz Sheikh,Milan Sova,Ana Todo-Bom,Luís Taborda-Barata,Sanna Toppila-Salmi,Joaquín Sastre,Ioanna Tsiligianni,Arunas Valiulis,Olivier Vandenplas,Dana Wallace,Susan Waserman,Arzu Yorgancioglu,Mihaela Zidarn,Torsten Zuberbier,João Eurico Fonseca,Jean Bousquet
摘要
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”). Objective To compare AR pharmacological treatments on (i) daily symptoms, (ii) frequency of use in co-medication, (iii) visual analogue scale (VAS) 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 patient, and controlling for confounding factors. We compared (i) allergy symptoms between patients with and without AIT and (ii) different drug classes used in comedication. 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 chances of being used in co-medication (adjusted OR=0.75; 95%CI=0.71-0.80). Conclusions 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.