S Dhami1, A Kakourou2, F Asamoah3, I Agache4, S Lau5, M Jutel6,7, A Muraro8, G Roberts9,10,11, C A Akdis12, M Bonini13, O Cavkaytar14,15, B Flood16, P Gajdanowicz6, K Izuhara17, Ö Kalayci18, R Mosges19, O Palomares20, O Pfaar21,22, S Smolinska6,7, M Sokolowska12, M Asaria23, G Netuveli24, H Zaman25, A Akhlaq26, A Sheikh27. 1. Evidence-Based Health Care Ltd, Edinburgh, UK. 2. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. 3. Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. 4. Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania. 5. Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany. 6. Wroclaw Medical University, Wroclaw, Poland. 7. ALL-MED Medical Research Institute, Wroclaw, Poland. 8. Food Allergy Referral Centre Veneto Region, University Hospital of Padua, Padua, Italy. 9. The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK. 10. NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 11. Faculty of Medicine, University of Southampton, Southampton, UK. 12. Swiss Institute for Allergy and Asthma Research, Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland. 13. National Heart and Lung Institute, Imperial College London, London, UK. 14. Department of Allergy and Clinical Immunology, Sami Ulus Women's & Children's Diseases Training and Research Hospital, Ankara, Turkey. 15. Department of Pediatric Allergy and Immunology, Ulus Women's & Children's Diseases Training and Research Hospital, Ankara, Turkey. 16. European Federation of Allergy and Airways Diseases Patients Association, Brussels, Belgium. 17. Saga Medical School, Nabeshima, Japan. 18. Hacettepe University, Ankara, Turkey. 19. Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Köln, Germany. 20. Department of Biochemistry and Molecular Biology, Complutense University of Madrid, Madrid, Spain. 21. Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 22. Center for Rhinology and Allergology, Wiesbaden, Germany. 23. Centre for Health Economics, University of York, York, UK. 24. Institute for Health and Human Development, University of East London, London, UK. 25. Bradford School of Pharmacy, Bradford, UK. 26. Health and Hospital Management, Institute of Business Management, Karachi, Pakistan. 27. Asthma UK Centre for Applied Research, The University of Edinburgh, Edinburgh, UK.
Abstract
BACKGROUND: To inform the development of the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT. METHODS: We performed a systematic review, which involved searching nine databases. Studies were screened against predefined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses. RESULTS: 98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of -1.11 (95% CI -1.66, -0.56). This was robust to a prespecified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD -1.21 (95% CI -1.87, -0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95% CI -0.23, 0.58), but one study showed a beneficial long-term effect. For secondary outcomes, subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen-specific airway hyperreactivity (AHR), but this was not the case for sublingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and nonspecific AHR. AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported. The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective. CONCLUSIONS: AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness.
BACKGROUND: To inform the development of the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT. METHODS: We performed a systematic review, which involved searching nine databases. Studies were screened against predefined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses. RESULTS: 98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of -1.11 (95% CI -1.66, -0.56). This was robust to a prespecified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD -1.21 (95% CI -1.87, -0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95% CI -0.23, 0.58), but one study showed a beneficial long-term effect. For secondary outcomes, subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen-specific airway hyperreactivity (AHR), but this was not the case for sublingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and nonspecific AHR. AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported. The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective. CONCLUSIONS: AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness.
Authors: Mohamed S Al-Moamary; Sami A Alhaider; Abdullah A Alangari; Mohammed O Al Ghobain; Mohammed O Zeitouni; Majdy M Idrees; Abdullah F Alanazi; Adel S Al-Harbi; Abdullah A Yousef; Hassan S Alorainy; Mohamed S Al-Hajjaj Journal: Ann Thorac Med Date: 2019 Jan-Mar Impact factor: 2.219
Authors: Ann-Kathrin Richter; Ludger Klimek; Hans F Merk; Norbert Mülleneisen; Harald Renz; Wolfgang Wehrmann; Thomas Werfel; Eckard Hamelmann; Uwe Siebert; Gaby Sroczynski; Jürgen Wasem; Janine Biermann-Stallwitz Journal: Eur J Health Econ Date: 2018-03-24