Adherence to AIT Treatment in RWD Analyses
Like with any other chronic disease medication adherence to AIT is of
high importance for treatment efficacy (1,2), but is generally lower
than assumed by physicians (1).
Data on adherence were collected in 7 publications (14,15,17,20,23–25),
where different terms (adherence, compliance, persistence) and
definitions were used so that the results are difficult to compare.
Definitions varied from defining patients being adherent or persistent
when receiving just one prescription per year (20,23) to detailed
calculation based on the potential expiry of single packages while
defining maximum treatment or pharmacy visits gaps (14,17,24). In two
assessments ’days on therapy’ were defined as an additional parameter
(14,17). In summary, the data consistently show that medication
adherence drops during the three years of AIT independently from the
preparation used.
Adherence data from RCTs cannot be transferred into real life since the
conditions are completely different. Adherence is reported to be higher
in clinical studies than in real-life surveys (2). RCTs follow a strict
protocol, patients are often supervised by study nurses and might be
paid for their participation so that adherence is artificially increased
(14).
Three assessments resulted in a higher medication adherence to SCIT than
to SLIT (14,17,24). The two assessments showing divergent results for
persistence in the SLIT and SCIT sub-cohorts defined patients being
persistent when receiving at least one prescription in both, the second
and third year of AIT - thereby ignoring the application recommendations
in the summary of product characteristics and so the range of coverage
of the single packs available for each preparation (20,23).
Nevertheless, the study by Allam et al. also showed that patients
discontinued SLIT in the first year of AIT more frequently than SCIT
patients (20), which was also shown in other studies (14,17,24). The
authors assume that early oral side effects during SLIT are particularly
responsible for the higher discontinuation rates in the first year
(20,24). Additionally, inconvenience, lack of efficacy or forgetfulness
may drop adherence (2). Therefore, patient education and good
communication between physicians and patients are fundamental for a good
medication adherence (2). Improving AIT adherence is one of the most
important future goals for ensuring efficacy (1) with some options being
reminder mechanisms via mobile phones (e.g. alarms, short message
service (SMS), apps) (2). Meanwhile some mobile phone apps are available
but a meta-analysis found that most did not contain the desirable
features and were of low quality (49). With the MASK-rhinitis (Mobile
Airways Sentinel NetworK for allergic rhinitis) a patient-centred
information and communication system is operational for patients
suffering from allergic rhinitis in more than 20 countries (50). The
mobile phone app MASK-air® was already used to investigate adherence to
symptomatic treatment in patients suffering from allergic rhinitis
indicating a low adherence in this real-world setting from a European
population sample (49). Respective data for adherence to AIT are not yet
available but desirable.