Predicting allergen immunotherapy efficacy based on early maintenance phase response in routine clinical practice

IF 3.9 2区医学 Q2 ALLERGY World Allergy Organization Journal Pub Date : 2024-11-14 DOI:10.1016/j.waojou.2024.100986

Rundong Qin MD , Wanyi Fu Ph.D , Renbin Huang MD , Mo Xian MD, Yubiao Guo MD, Li He MD, Xu Shi MD, Jing Li MD

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Abstract

Background

While allergen-specific immunotherapy (AIT) is acknowledged as an effective treatment, its efficacy varies, and consensus on predictive indicators for AIT responders remains elusive.

Objective

This study aimed to identify alternative parameters for predicting AIT responders based on clinical data collected in daily practice.

Method

We conducted a retrospective analysis of patients with house-dust-mite-driven asthma and/or rhinitis who completed 3 years of subcutaneous AIT (3y-AIT). We assessed the efficacy of AIT using the estimated daily symptom and medication score (edSMS) during different treatment periods, including up-dosing, maintenance I, II, and III phases. These scores were derived from detailed records of symptoms and medication use for AIT injections. A responder was defined as an individual with a reduction in edSMS of at least 30% from up-dosing to maintenance III phase (ΔedSMS_U-M3).

Results

A cohort of 133 patients was analyzed, revealing a significant overall improvement in the disease condition after 3y-AIT. Responders demonstrated lower rates of polysensitization, daily tobacco smoke exposure, and milder pretreatment disease severity compared to non-responders (p = 0.003, p = 0.001, and p = 0.019, respectively). We observed 8 clinical response patterns among included subjects, but only a small group of patients (16/133, 12.03%) demonstrated consistent improvement throughout the 3y-AIT. Serum total immunoglobulin E (tIgE), specific immunoglobulin E (sIgE), sIgE/tIgE ratios, and edSMS during the up-dosing phase failed to differentiate the clinical response patterns or correlate with 3y-AIT efficacy. Notably, the reduction in edSMS from up-dosing phase to maintenance I phase (ΔedSMS_U-M1) significantly associated with the 3y-AIT outcome (r = 0.443, p < 0.001). Receiver-operating characteristic curves indicated that ΔedSMS_U-M1, with a cut-off of 18.40%, effectively predicted responders (AUC: 0.75, sensitivity: 76.20%, specificity: 76.70%).

Conclusion

The individualized clinical responses to AIT may pose challenges in identifying predictors for treatment efficacy. Nonetheless, despite this complexity, our study highlights that the effectiveness observed in the early maintenance phase serves as a suitable predictor of 3y-AIT outcomes.

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根据常规临床实践中早期维持阶段的反应预测过敏原免疫疗法的疗效

背景虽然过敏原特异性免疫疗法（AIT）被公认为是一种有效的治疗方法，但其疗效却参差不齐，而且对 AIT 反应者的预测指标仍未达成共识。方法我们对完成了 3 年皮下 AIT（3y-AIT）治疗的由屋尘螨引起的哮喘和/或鼻炎患者进行了回顾性分析。在不同的治疗阶段，包括加量、维持 I、II 和 III 阶段，我们使用每日症状和用药估计评分（edSMS）来评估 AIT 的疗效。这些评分来自 AIT 注射时的症状和用药详细记录。结果对 133 例患者进行了分析，结果显示，经过 3 年的 AIT 治疗后，患者的总体病情得到了显著改善。与非应答者相比，应答者的多敏化率、每日烟草烟雾暴露率和治疗前疾病严重程度较轻（分别为 p = 0.003、p = 0.001 和 p = 0.019）。在纳入的受试者中，我们观察到 8 种临床反应模式，但只有一小部分患者（16/133，12.03%）在 3 年的 AIT 中表现出持续的改善。血清总免疫球蛋白 E (tIgE)、特异性免疫球蛋白 E (sIgE)、sIgE/tIgE 比率和加药阶段的 edSMS 未能区分临床反应模式或与 3 年的 AIT 疗效相关。值得注意的是，从加量给药阶段到维持 I 阶段，edSMS 的降低（ΔedSMSU-M1）与 3y-AIT 的结果显著相关（r = 0.443，p < 0.001）。接收者工作特征曲线显示，ΔedSMSU-M1 的临界值为 18.40%，可有效预测应答者（AUC：0.75，灵敏度：76.20%，特异性：76.70%）。尽管如此，尽管存在这种复杂性，我们的研究强调，在早期维持阶段观察到的疗效是预测 AIT 3 年疗效的合适指标。

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来源期刊

World Allergy Organization Journal Immunology and Microbiology-Immunology

CiteScore

9.10

自引率

5.90%

发文量

审稿时长

9 weeks

期刊介绍： The official pubication of the World Allergy Organization, the World Allergy Organization Journal (WAOjournal) publishes original mechanistic, translational, and clinical research on the topics of allergy, asthma, anaphylaxis, and clincial immunology, as well as reviews, guidelines, and position papers that contribute to the improvement of patient care. WAOjournal publishes research on the growth of allergy prevalence within the scope of single countries, country comparisons, and practical global issues and regulations, or threats to the allergy specialty. The Journal invites the submissions of all authors interested in publishing on current global problems in allergy, asthma, anaphylaxis, and immunology. Of particular interest are the immunological consequences of climate change and the subsequent systematic transformations in food habits and their consequences for the allergy/immunology discipline.