Retrospective cohort study to demonstrate the impact on atopic dermatitis (AD) occurrence and progression of a 2-years or more treatment with a depigmented allergoid in Germany under real life conditions, based on IMS® LRx

Angelika Sager (Witten, Germany), Thomas Müller (Ismaning, Germany), Hartmut Richter (Frankfurt am Main, Germany), Nemat Katja (Dresden, Germany)

Background

Atopic dermatitis treatment was assessed separately for various Allergen Immunotherapy (AIT) forms in the grass (GR), early flowering trees (EFT) and house dust mites (HDM) markets using the German LRx database of IQVIA. For each market, patients with at least one AIT prescription (Rx) in an allergen specific timespan < 9-year were identified and tracked. Three groups representing the major products were defined in each market: subcutaneous AIT with depigmented, polymerized allergen extract (dSCIT), other subcutaneous AIT (oSCIT) and sublingual AIT (SLIT).

Method

We investigated the impact of the AIT treatment on the occurrence and progression of atopic dermatitis measured with use of AD medication.

To assess the AD status the following substance classes were used: Topical corticosteroids in mono form (ATC D07A) or in combination with antibiotics/antimycotics (ATC D07B), topical immune modulators in ATC D05X0 (Tacrolimus, Pimecrolimus) and oral/systemic immune modulators in ATC L04X0 (Ciclosporin, Tacrolimus, Everolimus, Sirolimus) based on EphMRA system. The following patients were included:

Allergen	dSCIT	oSCIT	SLIT	control
GR	1,492	7,993	1,950	34,305
EFT	1,663	9,266	1,056	35,865
HDM	2,110	4,928	222	21,780

Results

In GR sensitized patients SLIT and SCIT showed a statistically significant benefit in AD occurrence and progression; based on the number of Rx consumed, for progression dSCIT showed the best results.

In EFT sensitized patients dSCIT showed better effects in AD occurrence and progression, while SLIT showed no effect on AD progression.

In HDM sensitized patients dSCIT and oSCIT showed a statistically significant effect on AD progression and occurrence. Results for SLIT were inconclusive due to low patient number.

Conclusion

Real world data based on IMS LRx are useful to generate AIT real world evidence compared to control where no AIT is applied. Since SLIT with EFT andHDM are shorter on the market than dSCIT and oSCIT the results are compromised due to lower patient numbers, nevertheless, it seemsthat SLIT has a weaker effect on AD occurrence and progression compared to SCIT preparations. DSCIT and oSCIT may prevent AD occurrence and progression significantly better added to symptomatic treatment, although further studies that confirms these findings should be performed.