Allergic Rhinitis Therapy Decisions During a Routine Consultation: A Multicenter, Cross-Sectional Survey

Abstract

Background

Allergic rhinitis (AR) is characterized by nasal and ocular symptoms, and substantially impacts the quality of life. Therapy selection for patients with AR depends on several factors, including symptom severity, age, patient preference, patient adherence, and cost.

Methods

The purpose of this multicenter, noninterventional, cross-sectional survey was to evaluate current therapy decisions in routine clinical practice for patients with symptomatic AR, and to determine how these decisions are linked to experiences with previous treatments and current symptom severity as assessed by aVAS. The survey included patients aged 18 years or older in Spain and 12 years or older in Hungary who consulted a physician for treatment of AR symptoms. Physicians recorded AR symptom burden in the previous 7 days, previous AR treatments, and the current AR therapy decision made at the visit.

Results

Overall, 72.9% of 181 patients (Spain) and 67.1% of 228 patients (Hungary) had received treatment in the previous 7 days. Among patients who had received step 3 treatment, 82.9% (Spain) and 75.8% (Hungary) received a free combination of intranasal corticosteroid (INCS) and antihistamines. Despite the high number of pretreated patients in both countries, 72.9% and 78.9% in Spain and Hungary, respectively, reported uncontrolled symptoms (VAS ≥50 mm). Of pretreated patients, 58.3% (Spain) and 61.4% (Hungary) received a step-up in treatment during the visit. Physicians more often prescribed a fixed combination of INCS and intranasal antihistamine than a free combination. However, of patients with uncontrolled symptoms who received previous therapy, 28.0% (Hungary) and 40.6% (Spain) did not receive a step-up as suggested by the guidelines.

Conclusion

Many patients suffering from acute AR symptoms consulted with their physician because of insufficient medications. Not all patients with uncontrolled symptoms received a step-up in treatment, underscoring the need for improved physician education to enhance AR management and control in accordance with consensus treatment guidelines.

Keywords:

• allergic rhinitis
• therapy
• decision-making
• guidelines
• intranasal corticosteroid
• antihistamine
• visual analog scale
• noninterventional

Abbreviations

AR, allergic rhinitis; ARIA, Allergic Rhinitis and its Impact on Asthma; a nongovernmental organization; INAH, intranasal antihistamine; INCS, intranasal corticosteroid; MACVI, Contre les MAladies Chroniques pour un VIeillissement Actif (fighting chronic diseases for active and healthy ageing), a reference site of the European Innovation Partnership on Active and Healthy Ageing; OAH, oral antihistamine; SD, standard deviation; SP, subpopulation; VAS, visual analog scale.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The investigation represented a noninterventional survey as defined by European regulations (ie, the rules imposed for this survey plan did not interfere with the physician’s common therapy). The study was carried out in accordance with the national laws and guidelines current at that time for conducting noninterventional studies and was approved by local ethics committees in Spain on May 9, 2018 (C.I. EPA18/026) Comité de Ética de la Investigación de la Comunidad Autonóma de Aragón and in Hungary on September 22, 2017 (OGYÈI/37070-11/2017) OGYEI, Országos Gyógyszerészeti és Élelmezés-egészségügyi Intézet.

Statement of Compliance

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants involved in the study.

Acknowledgments

We would like to thank the patients who participated in the trial. This paper was presented at the European Academy of Allergy & Clincial Immunology (EAACI) 2019 as a poster with interim findings: http://webcast.eaaci.cyim.com/mediatheque/media.aspx?mediaId=66705&channel=8518. The poster’s abstract was published in the European Journal of Allergy and Clinical Immunology: https://onlinelibrary.wiley.com/doi/10.1111/all.13961.

Author Contributions

GG, ME, AK, FK, DTN, and HCK have made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: drafting the work or revising it critically for important intellectual content; provided final approval of the version to be published; and are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure

GG was a paid consultant and speaker for AstraZeneca, Chiesi, BMS, MSD, Berlin-Chemi, Boehringer Ingelheim, Roche, Novartis, Pfizer, Orion, including Ipsen, and Mylan as a speaker. ME is an employee of MEDA Pharma GmbH & Co. KG (a Mylan Company). AK is a Mylan, Inc. employee and shareholder. AK has also been employed at Novartis and Lundbeck pharmaceutical companies. FK is an employee of MEDA Pharma GmbH & Co. KG (a Mylan Company). DTN is an employee of MEDA Pharma GmbH & Co. KG (a Mylan Company). HCK worked as a paid consultant for AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, and Novartis. The authors report no other conflicts of interest in this work.

Additional information

Funding

The design of the study and collection, analysis, and interpretation of data was funded by MEDA Pharma GmbH & Co. KG (a Mylan Company), Bad Homburg, Germany. Technical, editorial and medical writing assistance was provided to the authors by Erin Burns, PhD and Strategix, an affiliate of The Lynx Group LLC; funding for this support was provided by MEDA Pharma GmbH & Co. KG (a Mylan Company).