Subcutaneous and sublingual immunotherapy for seasonal allergic rhinitis: A systematic review and indirect comparison - 29/04/13
, Angela Meadows, MSc a, Nicola Novielli, PhD a, Aarnoud Huissoon, PhD b, Anne Fry-Smith, BA a, Catherine Meads, PhD c
Corresponding author: Janine Dretzke, MSc, Department of Public Health, Epidemiology & Biostatistics, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.Abstract |
Background |
Severe allergic rhinitis uncontrolled by pharmacotherapy can adversely affect quality of life. Both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) have demonstrated effectiveness in this patient group; however, it remains uncertain which route of administration is more effective.
Objectives |
We sought to update existing systematic reviews on the clinical effectiveness of SCIT and SLIT versus placebo, to undertake a systematic review of head-to-head trials, and to compare the relative effectiveness of SCIT and SLIT in an adjusted indirect comparison.
Methods |
Standard systematic review methods aimed at minimizing bias were used. Double-blind, randomized, placebo-controlled trials of SCIT or SLIT or trials of SCIT versus SLIT were included. Meta-analysis and indirect comparison meta-analysis with meta-regression were performed.
Results |
Updated meta-analyses confirmed statistically significant benefits for SCIT and SLIT compared with placebo in adults and, to a lesser extent, in children. Only 1 head-to-head trial met the inclusion criteria; both this and the indirect comparisons did not provide conclusive results in favor of either SCIT or SLIT based on symptom-medication or quality-of-life scores. There was a trend toward favoring SCIT for symptom and medication scores.
Conclusions |
Although there is clear evidence of effectiveness of both SCIT and SLIT, superiority of one mode of administration over the other could not be consistently demonstrated through indirect comparison, and further research is needed to establish the comparative effectiveness of SCIT versus SLIT.
Le texte complet de cet article est disponible en PDF.Key words : Allergic rhinitis, sublingual immunotherapy, subcutaneous immunotherapy, systematic review, meta-analysis, indirect comparison, meta-regression
Abbreviations used : AR, CrI, PRISMA, RCT, SCIT, SLIT, SMD, SSD
Plan
| This work formed part of a wider project commissioned and funded by the UK National Institute for Health Research Health Technology Assessment Programme as project no. 09/78/01. |
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| Disclosure of potential conflict of interest: J. Dretzke, A. Meadows, N. Novielli, A. Fry-Smith, and C. Meads have received research support from the National Institute for Health Research Health Technology Assessment Programme. A. Huissoon has received consultancy fees from the Meda advisory board, has received lecture fees from and holds stock in GlaxoSmithKline, has received travel support from ALK-Abelló, and ALK-Abelló and Meda Pharmaceuticals have sponsored annual allergy training meetings that his department organizes for primary care physicians. |
Vol 131 - N° 5
P. 1361-1366 - mai 2013 Retour au numéro
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