The following is a summary of “IR (index of reactivity)-house dust mite sublingual immunotherapy liquid formulation for allergic rhinoconjunctivitis: Systematic review and meta-analysis of randomized and nonrandomized studies,” published in the May 2024 issue of Allergy & Immunology by Bona, et al.
While randomized controlled trials (RCTs) are the gold standard for evidence in allergen immunotherapy (AIT), nonrandomized studies (NRS) are crucial for validating these results in more representative populations, especially concerning treatment duration and persistence. However, discrepancies between RCT and NRS outcomes can undermine the reliability of NRS due to perceived methodological flaws. For a study, researchers sought to compare the benefits of sublingual AIT (SLIT) for allergic rhinoconjunctivitis in NRS versus RCTs, focusing on a single product/allergen to minimize heterogeneity.
A meta-analysis was conducted using studies on house dust mite (HDM) SLIT liquid formulations sourced from computerized databases (Medline, Web of Science, and LILACS) and manual searches up to January 2023. Populations, treatments, and outcomes were combined using the DerSimonian-Laird method. Noncomparative NRS were compared to the SLIT arm of RCTs before and after treatment. Efficacy was determined by the standardized mean difference (SMD) in symptom score (SS) and medication score (MS).
The analysis included data from 12 NRS (682 patients) and 8 RCTs (176 patients). Significant benefits of IR-HDM SLIT liquid formulation were observed in both NRS (SS: SMD = −1.27; 95% CI, −1.64 to −0.90) and RCTs (SS: SMD = −0.56; 95% CI, −0.90 to −0.21). Similarly, for MS, the SMD was −1.35 (95% CI, −1.77 to −0.93) in NRS and −0.46 (95% CI, −0.67 to −0.25) in RCTs. Metaregression analysis indicated that symptom improvement correlated with treatment duration, showing consistent results in both NRS and RCTs with 12-month SS data: −0.87 (interquartile range, −1.02 to −0.77) for NRS and −0.75 (interquartile range, −0.93 to −0.41) for RCTs.
The meta-analysis demonstrated comparable clinical benefits of IR-HDM SLIT liquid formulation in both NRS and RCTs, with increasing efficacy over time. The findings suggested that NRS can reliably supplement RCT results and should be considered in guideline development.
Reference: jaci-global.org/article/S2772-8293(24)00004-3/fulltext
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