Comparison of rhinitis treatments using MASK‐air® data and considering the minimal important difference
Authors: Sousa‐Pinto Bernardo , Schünemann Holger J. , Sá‐Sousa Ana , Vieira Rafael José , Amaral Rita , Anto Josep M. , Klimek Ludger , Czarlewski Wienczyslawa , Mullol Joaquim , Pfaar Oliver , Bedbrook Anna , Brussino Luisa , Kvedariene Violeta , Larenas‐Linnemann Desirée , Okamoto Yoshitaka , Ventura Maria Teresa , Agache Ioana , Ansotegui Ignacio J. , Bergmann Karl C. , Bosnic‐Anticevich Sinthia , Brozek Jan , Canonica G. Walter , Cardona Victoria , Carreiro‐Martins Pedro , Casale Thomas , Cecchi Lorenzo , Chivato Tomas , Chu Derek K. , Cingi Cemal , Costa Elísio M. , Cruz Alvaro A. , Del Giacco Stefano , Devillier Philippe , Eklund Patrik , Fokkens Wytske J. , Gemicioglu Bilun , Haahtela Tari , Ivancevich Juan Carlos , Ispayeva Zhanat , Jutel Marek , Kuna Piotr , Kaidashev Igor , Khaitov Musa , Kraxner Helga , Laune Daniel , Lipworth Brian , Louis Renaud , Makris Michael , Monti Riccardo , Morais‐Almeida Mario , Mösges Ralph , Niedoszytko Marek , Papadopoulos Nikolaos G. , Patella Vincenzo , Pham‐Thi Nhân , Regateiro Frederico S. , Reitsma Sietze , Rouadi Philip W. , Samolinski Boleslaw , Sheikh Aziz , Sova Milan , Todo‐Bom Ana , Taborda‐Barata Luis , Toppila‐Salmi Sanna , Sastre Joaquin , Tsiligianni Ioanna , Valiulis Arunas , Vandenplas Olivier , Wallace Dana , Waserman Susan , Yorgancioglu Arzu , Zidarn Mihaela , Zuberbier Torsten , Fonseca Joao A. , Bousquet Jean 
Published: May 2022

Background

Different treatments exist for allergic rhinitis (AR), including pharmacotherapy and allergen immunotherapy (AIT), but they have not been compared using direct patient data (i.e., “real‐world data”). We aimed to compare AR pharmacological treatments on (i) daily symptoms, (ii) frequency of use in co‐medication, (iii) visual analogue scales (VASs) on allergy symptom control considering the minimal important difference (MID) and (iv) the effect of AIT.

Methods

We assessed the MASK‐air® app data (May 2015–December 2020) by users self‐reporting AR (16–90 years). We compared eight AR medication schemes on reported VAS of allergy symptoms, clustering data by the patient and controlling for confounding factors. We compared (i) allergy symptoms between patients with and without AIT and (ii) different drug classes used in co‐medication.

Results

We analysed 269,837 days from 10,860 users. Most days (52.7%) involved medication use. Median VAS levels were significantly higher in co‐medication than in monotherapy (including the fixed combination azelastine‐fluticasone) schemes. In adjusted models, azelastine‐fluticasone was associated with lower average VAS global allergy symptoms than all other medication schemes, while the contrary was observed for oral corticosteroids. AIT was associated with a decrease in allergy symptoms in some medication schemes. A difference larger than the MID compared to no treatment was observed for oral steroids. Azelastine‐fluticasone was the drug class with the lowest chance of being used in co‐medication (adjusted OR = 0.75; 95% CI = 0.71–0.80).

Conclusion

Median VAS levels were higher in co‐medication than in monotherapy. Patients with more severe symptoms report a higher treatment, which is currently not reflected in guidelines.