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Treatment of house dust mite allergy

Speaker: Jean Bousquet

29 September 2012


Specific immunotherapy in house dust mite allergy 1- ARIA and new studies 2- Value of ARIA

3- Interpretation 4- Conclusions


Disclosures Prof Jean Bousquet, University of Montpellier •

Member of the Board: Stallergènes

Lecture fees: ALK

Consultancy: Stallergènes


SCIT in allergic rhinitis


SLIT in allergic rhinitis


SCIT and SLIT in allergic rhinitis & asthma


Specific immunotherapy in house dust mite allergy 1- ARIA and new studies 2- Value of ARIA


Guideline development by methodologists using GRADE Guideline assessment by experts Independent from Industry

Review by experts: specialists, GPs and patients

GRADE guideline Development of outputs ARIA GA2LEN EAACI-EFA-IPCRG‌.. e.g. ARIA pocket Guide

e.g.CARAT-ARIA-GA2LEN questionnaire

Dissemination to GPs and patients Implementation

others


Quality of guidelines AGREE method Brozek et al, WAO 2012


Specific immunotherapy in house dust mite allergy

1- ARIA and new studies 2- Value of ARIA 3- Interpretation


Reporting SIT trials using CONSORT Bousquet PJ et al, J Allergy Clin Immunol 2011 sample size calculated

>2005 2001-2004 1996-2000

SLIT

randomization adequate ITT specified CONSORT chart patient per study>100 sample size calculated

SCIT

randomization adequate

ITT specified CONSORT chart patient per study>100 0

10

20

30

40

50

60

70 % papers


Reporting SIT trials using CONSORT Bousquet PJ et al, J Allergy Clin Immunol 2011 sample size calculated

>2005 2001-2004 1996-2000

SLIT

randomization adequate ITT specified CONSORT chart patient per study>100 sample size calculated

SCIT

randomization adequate

ITT specified CONSORT chart patient per study>100 0

10

20

30

40

50

60

70 % papers


Problems interpreting SLIT and SCIT studies • Great heterogenity between studies • Great heterogeneity between extracts and schedules • Most SCIT studies were reported using PP whereas SLIT tablets used ITT • It is proposed that meta-analyses should consider this methodologic problem

• SLIT using drops and tablets may not have similar pharmacokinetics • It is proposed to analyse in 2 sets SLIT with drops and SLIT with tablets


1- Severity of patients and persistent AR


FFNS improves nasal symptoms Rosenblut et al, Allergy 2007

Mean change from baseline rTNSS

Other endpoints: Mean change from baseline in daily rTNSS over the 52-week study period 0.0 Placebo Flucticasone furoate 110 g od

–0.5 –1.0 –1.5 –2.0 –2.5 –3.0 –3.5

–4.0 –4.5 –5.0 BL

28

P<0.0001 vs placebo for 1–52 weeks

56

84 112 140 168 196 224 252 280 308 336 364

Day BL, baseline


1- Severity of patients and persistent AR 2- Placebo 3- Allergen exposure • Run in period: pollen vs persistent • Variability between years • Climate change and prediction of season • Persistent rhinitis should be studied with perennial allergens


1- Severity of patients 2- Placebo 3- Allergen exposure 4- Analysis and reporting of the study 5- level of symptoms during the allergen exposure

6- Clinical relevance of SIT

7- Combined symptom-medication scores


1- Severity of patients

2- Placebo 3- Allergen exposure 4- Analysis and reporting of the study 5- level of symptoms during the allergen exposure 6- Clinical relevance of SIT 7- Combined symptom-medication scores 8- Outcomes

9- Efficacy in children may be less than in adults


Representativity of RCTs in allergic rhinitis Costa et al, J Allergy Clin Immunol 2011

7.4% patients are within the criteria of RCTs 100 90

Percent of errors

80 70

60 50 40 30 20 10 0


Specific immunotherapy in house dust mite allergy 1- ARIA and new studies 2- Value of ARIA

3- Interpretation 4- Conclusions


Current studies do not make it possible to conclude in HDM allergy We are waiting new studies Only these studies should be considered in guidelines

Jean Bousquet