变应原免疫治疗用于桦树花粉相关变应性鼻炎及哮喘的真实世界获益
2018/11/13
摘要
背景：变应原免疫疗法[AIT;皮下/舌下免疫治疗(SCIT/SLIT)] 是治疗变应性鼻炎(AR)的唯一一种长期有效的方法，但该疗法的益处在真实世界研究中的证据很少这项真实世界的研究评估了6种AITs(天然花粉SLIT/SCIT, 4种过敏原SCITs)与对症治疗药物相比，对桦树花粉相关性AR和/或哮喘患者AR症状和哮喘发作治疗的效果。
方法：在德国纵向处方数据库的回顾性队列分析中，AIT患者接受了≥2个连续的季节性治疗周期;非AIT患者在3个季节或先前已有≥3份AR处方。患者按年度指数、年龄、性别、主要指标指数、治疗期内季节性周期数、基线AR/哮喘治疗处方进行匹配。多元回归分析比较了AIT和非AIT组中的处方数据作为临床状态/疾病进展的指标。
结果：在长达6年的随访中，AIT(65.4%)较非AIT(47.4%)患者无AR治疗者显著增多[优势比(OR)][95%置信区间(CI)]:0.51[(0.480.54);p<0.001](28.6%的协变量调整减少vs非AIT;p<0.001)，并且AIT(49.1%)较未接受AIT(35.1%)疗法的患者无哮喘药物治疗者显著增多或可显著减少现有哮喘药物的使用[OR (95% CI): 0.60 (0.55 0.65);p<0.001](32%比non-AIT;p<0.001)，(32%协变调整减少vs非AIT;p < 0.001)。在治疗期
结论：在真实世界研究中，桦树花粉变应原免疫治疗可显著减少AR和哮喘药物的使用，并显著降低在治疗过程中因新发哮喘使用药物治疗的风险，疗效长达六年。
Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma.
Wahn U, Bachert C, et al. Allergy , 2018 Sep 05
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 6 AITs (native pollen SLIT/SCIT, 4 allergoid SCITs) versus 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 3 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): 0.60 (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：变应原免疫疗法[AIT;皮下/舌下免疫治疗(SCIT/SLIT)] 是治疗变应性鼻炎(AR)的唯一一种长期有效的方法，但该疗法的益处在真实世界研究中的证据很少这项真实世界的研究评估了6种AITs(天然花粉SLIT/SCIT, 4种过敏原SCITs)与对症治疗药物相比，对桦树花粉相关性AR和/或哮喘患者AR症状和哮喘发作治疗的效果。
方法：在德国纵向处方数据库的回顾性队列分析中，AIT患者接受了≥2个连续的季节性治疗周期;非AIT患者在3个季节或先前已有≥3份AR处方。患者按年度指数、年龄、性别、主要指标指数、治疗期内季节性周期数、基线AR/哮喘治疗处方进行匹配。多元回归分析比较了AIT和非AIT组中的处方数据作为临床状态/疾病进展的指标。
结果：在长达6年的随访中，AIT(65.4%)较非AIT(47.4%)患者无AR治疗者显著增多[优势比(OR)][95%置信区间(CI)]:0.51[(0.480.54);p<0.001](28.6%的协变量调整减少vs非AIT;p<0.001)，并且AIT(49.1%)较未接受AIT(35.1%)疗法的患者无哮喘药物治疗者显著增多或可显著减少现有哮喘药物的使用[OR (95% CI): 0.60 (0.55 0.65);p<0.001](32%比non-AIT;p<0.001)，(32%协变调整减少vs非AIT;p < 0.001)。在治疗期
结论：在真实世界研究中，桦树花粉变应原免疫治疗可显著减少AR和哮喘药物的使用，并显著降低在治疗过程中因新发哮喘使用药物治疗的风险，疗效长达六年。
（复旦大学附属中山医院呼吸与危重症医学科 魏婷婷 摘译 毕晶 审校）
（Allergy , 2018 Sep 05）
（Allergy , 2018 Sep 05）
Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma.
Wahn U, Bachert C, et al. Allergy , 2018 Sep 05
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 6 AITs (native pollen SLIT/SCIT, 4 allergoid SCITs) versus 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 3 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): 0.60 (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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综合方法确定不同哮喘患者的皮质类固醇反应变异
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长期口服糖皮质激素(OCS)治疗成人重症哮喘的作用及其相关副作用
