Efficacy of subcutaneous and sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: A meta-analysis–based comparison Danilo Di.

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Presentation transcript:

Efficacy of subcutaneous and sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: A meta-analysis–based comparison Danilo Di Bona, MD, PhD, Antonella Plaia, PhD, Maria Stefania Leto-Barone, MD, Simona La Piana, MD, Gabriele Di Lorenzo, MD Journal of Allergy and Clinical Immunology Volume 130, Issue 5, Pages 1097-1107.e2 (November 2012) DOI: 10.1016/j.jaci.2012.08.012 Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Meta-analysis of 36 RTCs of allergen specific immunotherapy versus placebo for seasonal allergic rhinosinusitis: 10 RCTs of SLIT-D (group 1), 12 RCTs of SLIT-T (group 2), and 14 RCTs of SCIT, using the random effects model. The SMD and 95% CI for the effect of allergen specific immunotherapy on symptom score are plotted on the graph. Studies of each group are arranged chronologically on the basis of the year of publication. For the studies by Pfaar and Klimek27 and Pastorello et al,40 the combined symptom-medication score was used. Journal of Allergy and Clinical Immunology 2012 130, 1097-1107.e2DOI: (10.1016/j.jaci.2012.08.012) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Descriptive subgroup analysis for symptom score of the 36 RCTs of allergen specific immunotherapy versus placebo for seasonal allergic rhinosinusitis. Box plots include the middle 50% of the data. The horizontal bars inside the boxes represent the median SMDs. The dotted lines to the whiskers extend to the most extreme data points, which are no more than 1.5 times the interquartile range from the box. Unicenter versus multicenter studies: SCIT median SMD unicenter, −1.28; SCIT median SMD multicenter, −0.42; SLIT median SMD unicenter, −0.53; SLIT median SMD multicenter, −0.22. Sample size [below/above the median sample size (MSS) of all the studies]: SCIT median SMD below MSS, −1.28; SCIT median SMD above MSS, −0.40; SLIT median SMD below MSS, −0.53; SLIT median SMD above MSS, −0.22. In some studies the symptom score was evaluated during the whole pollen season, in others during the week with the highest pollen count (peak): SCIT median SMD at peak, −0.89; SCIT median SMD whole season, −0.47; SLIT median SMD at peak, −0.69; SLIT median SMD whole season, −0.23. Duration of treatment: SCIT median SMD <12 months, −0.49; SCIT median SMD ≥12 months, −0.97; SLIT median SMD <12 months, −0.33; SLIT median SMD 12 months, −0.24. Rate of dropout and withdrawal (D/W) of individual studies (below/above the median value of 9.2%): SCIT median SMD <9.2%, −1.28; SCIT median SMD ≥9.2%, −0.45; SLIT median SMD <9.2%, −0.51; SLIT median SMD ≥9.2%, −0.20. Journal of Allergy and Clinical Immunology 2012 130, 1097-1107.e2DOI: (10.1016/j.jaci.2012.08.012) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Meta-analysis of 34 RTCs of allergen specific immunotherapy versus placebo for seasonal allergic rhinosinusitis: 10 RCTs of SLIT-D (group 1), 10 RCTs of SLIT-T (group 2), and 14 RCTs of SCIT, using the random effects models. The SMD and 95% CI for the effect of SLIT on medication score are plotted on the graph. Studies are arranged chronologically on the basis of the year of publication. For the studies by Pfaar and Klimek27 and Pastorello et al40 the combined symptom-medication score was used. Journal of Allergy and Clinical Immunology 2012 130, 1097-1107.e2DOI: (10.1016/j.jaci.2012.08.012) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Descriptive subgroup analysis for medication score of the 34 RCTs of allergen specific immunotherapy versus placebo for seasonal allergic rhinosinusitis. Box plots include the middle 50% of the data. The horizontal bars inside the boxes represent the median SMDs. The dotted lines to the whiskers extend to the most extreme data points, which are no more than 1.5 times the interquartile range from the box. Unicenter versus multicenter studies. SCIT median SMD: unicenter, −0.96; multicenter, 0.29. SLIT median SMD: unicenter, −0.79; multicenter, −0.17. Sample size [below/above the median sample size (MSS) of all the studies]: SCIT median SMD below MSS, −0.96; SCIT median SMD above MSS, −0.28; SLIT median SMD below MSS, −0.40; SLIT median SMD above MSS, −0.15. Peak/whole pollen season: SCIT median SMD at peak, −0.60; SCIT median SMD whole season, −0.51; SLIT median SMD at peak, −0.54; SLIT median SMD whole season, −0.22. Duration of treatment: SCIT median SMD <12 months, −0.51; SCIT median SMD ≥12 months, −0.75; SLIT median SMD <12 months, −0.28; SLIT median SMD ≥12 months, −0.30. Rate of dropout and withdrawal (D/W) of individual studies (below/above the median value of 9.2%): SCIT median SMD <9.2%, −0.60; SCIT median SMD ≥9.2%, −0.51; SLIT median SMD <9.2%, −0.53; SLIT median SMD ≥9.2%, −0.20. Journal of Allergy and Clinical Immunology 2012 130, 1097-1107.e2DOI: (10.1016/j.jaci.2012.08.012) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions