The journal of allergy and clinical immunology. In practice | 2021
Efficacy of subcutaneous and sublingual immunotherapy for house dust mite allergy: a network meta-analysis-based comparison.
Abstract
BACKGROUND\nMeta-analyses comparing the efficacy of sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) for house dust mite (HDM) allergy are lacking.\n\n\nOBJECTIVE\nTo compare the efficacy of SLIT drops, SLIT tablets, and SCIT in patients with perennial allergic rhinitis (AR) through network analysis.\n\n\nMETHODS\nFrequentist network meta-analyses estimated the standardized mean difference (SMD) across the three immunotherapy modalities on AR symptom and medication score data from double-blind randomized clinical trials (DBRCTs). Random effects models were investigated.\n\n\nRESULTS\nTwenty-six DBRCTs were included in this meta-analysis for the symptom score, and 18 DBRCTs were included for the medication score. In the direct pairwise meta-analysis, significant reduction of the symptom score was observed for all immunotherapy modalities as compared to the placebo: pooled SMDs of -0.461 (95% CI, -0.795 to -0.127) for SLIT-drop, -0.329 (95% CI, -0.426 to -0.231) for SLIT-tablet, and -1.669 (95% CI, -2.753 to -0.585) for SCIT. For the medication score, significant reduction was observed for all the modalities. In network meta-analysis, the clinical efficacy of SCIT based on the symptom score was greater than SLIT-drop or SLIT-tablet (SMD: -0.697, 95% CI, -1.105 to -0.288 and SMD: -0.819, 95% CI, -1.242 to -0.397). However, there was no significant difference in the symptom score between SLIT-drop and SLIT-tablet.\n\n\nCONCLUSION\nThis study demonstrated the clinical efficacy of all HDM immunotherapy modalities and suggested that SCIT may be more effective than SLIT drop or tablet in controlling symptoms of allergic rhinitis.