Allergy immunotherapy prescribing trends for grass pollen-induced allergic rhinitis in Germany: a retrospective cohort analysis

Allergy, Asthma & Clinical Immunology

Amanda L. McDonell¹  Ulrich Wahn³  Dirk Demuth¹  Catrina Richards¹  Charlie Hawes⁵  Jakob Nørgaard Andreasen²  Felicia Allen-Ramey⁴ 

[1] Real-World Evidence Solutions and Health Economics & Outcomes Research, IMS Health, 210 Pentonville Road, London N1 9JY, UK

[2] Global Market Access, ALK-Abelló A/S, Hørsholm, Denmark

[3] Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany

[4] Global Health Outcomes, Merck & Co., West Point 19486, PA, USA

[5] Worked at IMS Health at time of study, Real-World Evidence Solutions and Health Economics & Outcomes Research, London, UK

关键词: Rhinitis;    Grass pollen allergy;    Paediatrics;    Clinical immunology;    Allergens;   

Others  :  1218607
DOI  :  10.1186/s13223-015-0085-x

 received in 2015-02-24, accepted in 2015-05-20,  发布年份 2015

【 摘 要 】

Background

Allergy immunotherapy is an effective treatment for patients with allergic rhinitis whose symptoms are unresolved with pharmacotherapy. Allergy immunotherapy for grass pollen-induced allergic rhinitis is available in three modalities: subcutaneous immunotherapy and sublingual immunotherapy as a tablet or drop. This study aimed to understand trends in allergy immunotherapy prescribing and practice patterns for grass allergies in adult and paediatric patients in Germany.

Methods

A retrospective cohort study was conducted using IMS Disease Analyzer in Germany. Patients with an allergy immunotherapy prescription for grass pollen (Anatomical Therapeutic Chemical [ATC] classification code V01AA02) from September 2005 to December 2012 were included in the study. General Practitioners (GPs), dermatologists, Ear, Nose and Throat (ENT)-specialists, paediatricians and pneumologists were included as the allergy immunotherapy prescribing physicians in the study. Descriptive analyses were conducted on patient characteristics at index and prescribing physician specialty; a test for trend was conducted for timing of initiation of first allergy immunotherapy prescription in each annual prescribing season.

Results

Eighteen thousand eight hundred fifty eligible patients were identified during the study period. The majority of patients received subcutaneous immunotherapy; however, the proportion of patients receiving sublingual immunotherapy tablets increased from 8 % in 2006/2007 to 29 % in 2011/2012 (p < 0.001). Initiation of subcutaneous immunotherapy and Oralair® generally peaked during each prescribing year in two seasons (September-October and January) while GRAZAX® prescriptions peaked in autumn (September-October). ENT-specialists and dermatologists were the largest allergy immunotherapy prescribers in adults, while paediatricians and ENT-specialists were the largest prescribers of allergy immunotherapy in paediatric patients.

Conclusions

Subcutaneous immunotherapy remained the dominant allergy immunotherapy modality for grass pollen-induced allergic rhinitis in Germany for adult and paediatric patients; however, there was a marked increase in proportion of patients receiving sublingual immunotherapy tablets from 2006/2007 to 2011/2012, after their introduction to the market in 2006. ENT-specialists, dermatologists and paediatricians were responsible for the majority of prescribing. The predominance of particular modalities within certain physician specialties likely reflects different treatment goals or needs.

【 授权许可】

   
2015 McDonell et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]Bauchau V, Durham S. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004; 24:758-64.
• [2]Wilson D, Lime M, Durham SR. Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis. Allergy. 2005; 60:4-12.
• [3]Purello-D’Ambrosio F, Gangemi S, Merendino RA, Isola S, Puccinelli P, Parmiani S et al.. Prevention of new sensitizations in monosensitized subjects submitted to specific immunotherapy or not: a retrospective study. Clin Experimental Allergy. 2001; 31:1295-302.
• [4]Novembre E, Galli E, Landi F, Caffarelli C, Pifferi M, De Marco E et al.. Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2004; 114:851-7.
• [5]Möller C, Dreborg S, Ferdousi HA, Halken S, Høst A, Jacobsen L et al.. Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study). J Allergy Clin Immu. 2002; 109:251-6.
• [6]Marogna M, Tomassetti D, Bernasconi A, Colombo F, Massolo A, Di Rienzo Businco A et al.. Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study. Ann Allergy Asthma Immunol. 2008; 101:206-11.
• [7]Jacobsen L, Niggemann B, Dreborg S, Ferdousi HA, Halken S, Høst A et al.. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy. 2007; 62:943-8.
• [8]Jacobsen L. Preventive aspects of immunotherapy: prevention for children at risk of developing asthma. Ann Allergy Asthma Immunol. 2001; 87:43-6.
• [9]Eng PA, Borer-Reinhold M, Heijnen IAFM, Gnehm HPE. Twelve-year follow-up after discontinuation of preseasonal grass pollen immunotherapy in childhood. Allergy. 2006; 61:198-201.
• [10]Eng PA, Reinhold M, Gnehm HP. Long-term efficacy of preseasonal grass pollen immunotherapy in children. Allergy. 2002; 57:306-12.
• [11]Didier A, Malling HJ, Worm M, Horak F, Jäger S, André C et al.. Optimal dose, efficacy, and safety of once-daily sublingual immunotherapy with a 5–grass pollen tablet for seasonal allergic rhinitis. J Allergy Clin Immu. 2007; 120:1338-45.
• [12]Dahl R, Kapp A, Colombo G, de Monchy JGR, Rak S, Emminger W et al.. Efficacy and safety of sublingual immunotherapy with grass allergen tablets for seasonal allergic rhinoconjunctivitis. J Allergy Clin Immu. 2006; 118:434-40.
• [13]Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev. 2010; 8:CD001186.
• [14]Summary of Product Characteristics: Oralair 100 IR & 300 IR sublingual tablets. http://www.stallergenes.com/fileadmin/images/corporate/Emmanuelle/Oralair_SmPC.pdf (2013). Accessed 25 Nov 2014.
• [15]Summary of Product Characteristics: GRAZAX 75,000 SQ-T oral lyophilisate. http://www.medicines.orguk/emc/medicine/19565 (2014). Accessed 25 Nov 2014.
• [16]Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I et al.. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immu. 2011; 127:S1-55.
• [17]Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S et al.. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J. 2014; 7:6. BioMed Central Full Text
• [18]Nelson HS. Subcutaneous immunotherapy versus sublingual immunotherapy: which is more effective? J Allergy Clin Immunol Pract. 2014; 2:144-9.
• [19]Dretzke J, Meadows A, Novielli N, Huissoon A, Fry-Smith A, Meads C. Subcutaneous and sublingual immunotherapy for seasonal allergic rhinitis: a systematic review and indirect comparison. J Allergy Clin Immunol. 2013; 131:1361-6.
• [20]Hamilton JG. Needle phobia: a neglected diagnosis. J Fam Pract. 1995; 41:169-75.
• [21]Cox L, Calderon MA. Subcutaneous specific immunotherapy for seasonal allergic rhinitis: a review of treatment practices in the US and Europe. Curr Med Res Opin. 2010; 26:2723-33.
• [22]Becher H, Kostev K, Schröder-Bernhardi D. Validity and representativeness of the “Disease Analyzer” patient database for use in pharmaco-epidemiological and pharmacoeconomic studies. Int J Clin Pharm Th. 2009; 47:617-26.
• [23]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; 21:116-22.
• [24]Biermann J, Merk HF, Wehrmann W, Klimek L, Wasem J. Allergic disorders of the respiratory tract - findings from a large patient sample in the German statutory health insurance system. Allergo J. 2013; 22:366-73.
• [25]Cox L, Jacobsen L. Comparison of allergen immunotherapy practice patterns in the United States and Europe. Ann Allergy Asthma Immunol. 2009; 103:451-60.