Quantifying the benefits of early sublingual allergen immunotherapy tablet initiation in children.
allergen immunotherapy
allergic rhinitis
asthma
cost-effectiveness
prevention
Journal
Allergy
ISSN: 1398-9995
Titre abrégé: Allergy
Pays: Denmark
ID NLM: 7804028
Informations de publication
Date de publication:
26 Dec 2023
26 Dec 2023
Historique:
revised:
09
11
2023
received:
17
07
2023
accepted:
08
12
2023
medline:
26
12
2023
pubmed:
26
12
2023
entrez:
26
12
2023
Statut:
aheadofprint
Résumé
Allergic rhinitis (AR) is a chronic inflammatory disease of the upper airway, which progresses into allergic asthma (AA) in up to 45% of children. This analysis aimed to investigate clinical and economic benefits of sublingual allergen immunotherapy (SLIT tablets) initiated early in childhood for the treatment of AR by quantifying the long-term reduction in new cases of AA. A Markov model was developed to estimate the long-term effects of SLIT tablets on the risk of developing asthma. Key parameters were primarily based on data from the GRAZAX® Asthma Prevention trial and included the age- and treatment-dependent risk of developing AA as well as annual probabilities of progression/remission in AR severity. Healthcare costs were estimated using data from the REACT study. In a modelled cohort of children with moderate-to-severe seasonal AR initiated on SLIT tablets at ages 7 and 12, 24% and 29%, respectively, develop AA during a 20-year period. In comparison, when initiated at age 5, 19% develop AA. Additionally, initiation of SLIT tablets at age 5 is associated with a total healthcare cost of EUR 20,429 per patient, whereas initiation at ages 7 and 12 is associated with, respectively, EUR 21,050 and EUR 22,379 per patient 20 years after AR diagnosis. Initiation of SLIT tablets in early childhood is associated with a clinically meaningful and permanent reduction in new cases of AA and lower healthcare costs among children with AR. This finding supports the clinical relevance of initiating SLIT tablets early for children with AR to obtain long-term clinical benefits.
Sections du résumé
BACKGROUND
BACKGROUND
Allergic rhinitis (AR) is a chronic inflammatory disease of the upper airway, which progresses into allergic asthma (AA) in up to 45% of children. This analysis aimed to investigate clinical and economic benefits of sublingual allergen immunotherapy (SLIT tablets) initiated early in childhood for the treatment of AR by quantifying the long-term reduction in new cases of AA.
METHODS
METHODS
A Markov model was developed to estimate the long-term effects of SLIT tablets on the risk of developing asthma. Key parameters were primarily based on data from the GRAZAX® Asthma Prevention trial and included the age- and treatment-dependent risk of developing AA as well as annual probabilities of progression/remission in AR severity. Healthcare costs were estimated using data from the REACT study.
RESULTS
RESULTS
In a modelled cohort of children with moderate-to-severe seasonal AR initiated on SLIT tablets at ages 7 and 12, 24% and 29%, respectively, develop AA during a 20-year period. In comparison, when initiated at age 5, 19% develop AA. Additionally, initiation of SLIT tablets at age 5 is associated with a total healthcare cost of EUR 20,429 per patient, whereas initiation at ages 7 and 12 is associated with, respectively, EUR 21,050 and EUR 22,379 per patient 20 years after AR diagnosis.
CONCLUSION
CONCLUSIONS
Initiation of SLIT tablets in early childhood is associated with a clinically meaningful and permanent reduction in new cases of AA and lower healthcare costs among children with AR. This finding supports the clinical relevance of initiating SLIT tablets early for children with AR to obtain long-term clinical benefits.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : ALK, Bøge Allé 1, 2970 Hørsholm
Informations de copyright
© 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Références
Szeinbach SL, Seoane-Vazquez EC, Beyer A, Williams PB. The impact of allergic rhinitis on work productivity. Prim Care Respir J. 2007;16(2):98-105. doi:10.3132/pcrj.2007.00015
Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC. A survey of the burden of allergic rhinitis in Europe. Allergy. 2007;62(s85):17-25. doi:10.1111/j.1398-9995.2007.01549.x
Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008*: ARIA: 2008 update. Allergy. 2008;63:8-160. doi:10.1111/j.1398-9995.2007.01620.x
Canonica GW, Mullol J, Pradalier A, Didier A. Patient perceptions of allergic rhinitis and quality of life. World Allergy Organ J. 2008;1(9):138-144. doi:10.1097/WOX.0b013e3181865faf
Bosnic-Anticevich S, Smith P, Abramson M, et al. Impact of allergic rhinitis on the day-to-day lives of children: insights from an Australian cross-sectional study. BMJ Open. 2020;10(11):e038870. doi:10.1136/bmjopen-2020-038870
Blaiss MS, Hammerby E, Robinson S, Kennedy-Martin T, Buchs S. The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents. Ann Allergy Asthma Immunol. 2018;121(1):43-52.e3. doi:10.1016/j.anai.2018.03.028
Bousquet J, Schünemann HJ, Samolinski B, et al. Allergic rhinitis and its impact on asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol. 2012;130(5):1049-1062. doi:10.1016/j.jaci.2012.07.053
Jacobsen L, Niggemann B, Dreborg S, et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy. 2007;62(8):943-948. doi:10.1111/j.1398-9995.2007.01451.x
Burgess JA, Walters EH, Byrnes GB, et al. Childhood allergic rhinitis predicts asthma incidence and persistence to middle age: a longitudinal study. J Allergy Clin Immunol. 2007;120(4):863-869. doi:10.1016/j.jaci.2007.07.020
de Groot EP, Nijkamp A, Duiverman EJ, Brand PLP. Allergic rhinitis is associated with poor asthma control in children with asthma. Thorax. 2012;67(7):582-587. doi:10.1136/thoraxjnl-2011-201168
Murray CS. Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children. Thorax. 2006;61(5):376-382. doi:10.1136/thx.2005.042523
van Gent R, van Essen-Zandvliet EEM, Klijn P, Brackel HJL, Kimpen JLL, van Der Ent CK. Participation in daily life of children with asthma. J Asthma. 2008;45(9):807-813. doi:10.1080/02770900802311477
Pedersen S. Asthma control in children: is it important and can we measure it? Paediatr Respir Rev. 2016;17:36-38. doi:10.1016/j.prrv.2015.08.009
Schramm B, Ehlken B, Smala A, Quednau K, Berger K, Nowak D. Cost of illness of atopic asthma and seasonal allergic rhinitis in Germany: 1-yr retrospective study. Eur Respir J. 2003;21(1):116-122. doi:10.1183/09031936.03.00019502
Leynaert B, Neukirch C, Liard R, Bousquet J, Neukirch F. Quality of life in allergic rhinitis and asthma: a population-based study of young adults. Am J Respir Crit Care Med. 2000;162(4):1391-1396. doi:10.1164/ajrccm.162.4.9912033
Nolte H, Bernstein DI, Nelson HS, Ellis AK, Kleine-Tebbe J, Lu S. Efficacy and safety of ragweed SLIT-tablet in children with allergic Rhinoconjunctivitis in a randomized, placebo-controlled trial. J Allergy Clin Immunol Pract. 2020;8(7):2322-2331.e5. doi:10.1016/j.jaip.2020.03.041
Valovirta E, Petersen TH, Piotrowska T, et al. Results from the 5-year SQ grass sublingual immunotherapy tablet asthma prevention (GAP) trial in children with grass pollen allergy. J Allergy Clin Immunol. 2018;141(2):529-538.e13. doi:10.1016/j.jaci.2017.06.014
Wahn U, Tabar A, Kuna P, et al. Efficacy and safety of 5-grass-pollen sublingual immunotherapy tablets in pediatric allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2009;123(1):160-166.e3. doi:10.1016/j.jaci.2008.10.009
Matsuoka T, Bernstein DI, Masuyama K, et al. Pooled efficacy and safety data for house dust mite sublingual immunotherapy tablets in adolescents. Pediatr Allergy Immunol. 2017;28(7):661-667. doi:10.1111/pai.12747
Bufe A, Eberle P, Franke-Beckmann E, et al. Safety and efficacy in children of an SQ-standardized grass allergen tablet for sublingual immunotherapy. J Allergy Clin Immunol. 2009;123(1):167-173.e7. doi:10.1016/j.jaci.2008.10.044
Alvaro-Lozano M, Akdis CA, Akdis M, et al. Allergen immunotherapy in children User's guide. Pediatr Allergy Immunol. 2020;31(S25):1-101. doi:10.1111/pai.13189
Vogelberg C, Hamelmann E, Wahn U, Domdey A, Pollock RF, Grand TS. Cost-effectiveness of the SQ® grass SLIT-tablet in children with allergic rhinitis: a German payer perspective. Clin Outcomes Res. 2019;11:637-649. doi:10.2147/CEOR.S223383
Bachert C, Vestenbaek U, Christensen J, Griffiths UK, Poulsen PB. Cost-effectiveness of grass allergen tablet (GRAZAXs) for the prevention of seasonal grass pollen induced rhinoconjunctivitis - a northern European perspective. Clin Exp Allergy. 2007;37(5):772-779. doi:10.1111/j.1365-2222.2007.02706.x
Taylor M, Ronaldson S, Shenton R, Bech P. Economic evaluation of SQ-standardized grass allergy immunotherapy tablet (Grazax®) in children. Clin Outcomes Res. 2014;6:187-196. doi:10.2147/CEOR.S44079
Nasser S, Vestenbaek U, Beriot-Mathiot A, Poulsen PB. Cost-effectiveness of specific immunotherapy with Grazax in allergic rhinitis co-existing with asthma. Allergy. 2008;63(12):1624-1629. doi:10.1111/j.1398-9995.2008.01743.x
Canonica GW, Poulsen PB, Vestenbaek U. Cost-effectiveness of GRAZAX® for prevention of grass pollen induced rhinoconjunctivitis in southern Europe. Respir Med. 2007;101(9):1885-1894. doi:10.1016/j.rmed.2007.05.003
Bunne J, Hedman L, Perzanowski M, et al. The majority of children sensitized before school-age develop allergic disease before adulthood: a longitudinal population-based study. J Allergy Clin Immunol Pract. 2022;10(2):577-585.e3. doi:10.1016/j.jaip.2021.10.023
Akca U, Maslak IC. Department of Pediatric Allergy and Immunology, Akdeniz University, Faculty of Medicine, Antalya, Turkey, et al. the asthma risk is increased in children with severe allergic rhinitis. Turk Arch Pediatr. 2022;57(4):391-397. doi:10.5152/TurkArchPediatr.2022.21269
Fritzsching B, Contoli M, Porsbjerg C, et al. Long-term real-world effectiveness of allergy immunotherapy in patients with allergic rhinitis and asthma: results from the REACT study, a retrospective cohort study. Lancet Reg Health - Eur. 2022;13:100275. doi:10.1016/j.lanepe.2021.100275
LauerTaxe. Accessed April 12, 2023. https://www.cgm.com/deu_de/produkte/apotheke/lauer-taxe-en.html
Marogna M, Tomassetti D, Bernasconi A, et al. Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study. Ann Allergy Asthma Immunol. 2008;101(2):206-211. doi:10.1016/S1081-1206(10)60211-6
Zielen S, Devillier P, Heinrich J, Richter H, Wahn U. Sublingual immunotherapy provides long-term relief in allergic rhinitis and reduces the risk of asthma: a retrospective, real-world database analysis. Allergy. 2018;73(1):165-177. doi:10.1111/all.13213
Schmitt J, Schwarz K, Stadler E, Wüstenberg EG. Allergy immunotherapy for allergic rhinitis effectively prevents asthma: results from a large retrospective cohort study. J Allergy Clin Immunol. 2015;136(6):1511-1516. doi:10.1016/j.jaci.2015.07.038
Gradman J, Halken S. Preventive effect of allergen immunotherapy on asthma and new sensitizations. J Allergy Clin Immunol Pract. 2021;9(5):1813-1817. doi:10.1016/j.jaip.2021.03.010
Gabet S, Rancière F, Just J, et al. Asthma and allergic rhinitis risk depends on house dust mite specific IgE levels in PARIS birth cohort children. World Allergy Organ J. 2019;12(9):100057. doi:10.1016/j.waojou.2019.100057
Hill DA, Spergel JM. The atopic march. Ann Allergy Asthma Immunol. 2018;120(2):131-137. doi:10.1016/j.anai.2017.10.037
Forster F, Ege MJ, Gerlich J, et al. Trajectories of asthma and allergy symptoms from childhood to adulthood. Allergy. 2022;77(4):1192-1203. doi:10.1111/all.15075
Woehlk C, Ramu S, Sverrild A, et al. Allergen immunotherapy enhances airway epithelial antiviral immunity in patients with allergic asthma (VITAL study): a double blind randomized controlled trial. Am J Respir Crit Care Med. 2023;207:1161-1170. doi:10.1164/rccm.202209-1708OC
Global Initiative for Asthma. Pocket Guide for Asthma Management and Prevention (Adults and Children Older than 5 Years). 2022. https://ginasthma.org/wp-content/uploads/2022/07/GINA-2022-Pocket-Guide-WMS.pdf
Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343-373. doi:10.1183/09031936.00202013
Akmatov MK, Ermakova T, Holstiege J, Steffen A, von Stillfried D, Bätzing J. Comorbidity profile of patients with concurrent diagnoses of asthma and COPD in Germany. Sci Rep. 2020;10(1):17945. doi:10.1038/s41598-020-74966-1
Tan BK, Chandra RK, Pollak J, et al. Incidence and associated premorbid diagnoses of patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2013;131(5):1350-1360. doi:10.1016/j.jaci.2013.02.002
Ulrik CS, Nielsen M, Bårnes CB. Clinical characteristics of the asthma-COPD overlap syndrome - a systematic review. Int J Chron Obstruct Pulmon Dis. 2015;10:1443-1454. doi:10.2147/COPD.S85363
Fillard A, Licari A, Molinari N, Marseglia G, Demoly P, Caimmi D. Sensitivity of FEV1 and clinical parameters in children with a suspected asthma diagnosis. J Allergy Clin Immunol Pract. 2023;11(1):238-247. doi:10.1016/j.jaip.2022.10.011