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.