Silva D, Pereira AM, Santos N, Plácido JL, Reasons for discontinuing allergen subcutaneous immunotherapy. Allergy 2012;67(Suppl.96):235.

1. AIM
Describe
the
reasons
that
lead
to
discon0nuing
SCIT
without
medical
indica0on
and
compare
these
pa0ents
with
a
group
of
compliant
pa0ents.
Reasons
for
Discon-nuing
Allergen
Subcutaneous
Immunotherapy
Diana
Silva,
Ana
Pereira,
Natacha
Santos,
José
Luís
Plácido
Immunoallergology
Service,
Centro
Hospitalar
São
João,
EPE
-­‐
Porto,
Portugal
22%
17%
8%
8%
6%
4%
4%
4%
4%
P
METHODS
Cross-­‐sec0onal
study
of
an
inten0onal
sample
of
pa0ents
obtained
immunotherapy
admnistra0on
registers
from
Centro
Hospitalar
S.
João
(CHSJ).
RESULTS
CONCLUSION
Cost
was
the
main
factor
for
disconNnuing
immunotherapy.
Due
to
the
present
financial
situaNon
of
Portugal,
this
scenario
may
worsen.
Compliance
to
the
treatment
should
be
re-­‐enforced
and
the
economical
impact
of
immunotherapy
should
be
considered
Table
1.
ComparaNve
study
beetween
paNents
that
disconNnued
SCIT
without
medical
indicaNon
(n=56)
and
parNcipants
that
conNnued
or
disconNnued
SCIT
with
medical
indicaNon
(n=66)
DisconNnued
WITHOUT
medical
indicaNon
ConNnued
OR
disconNnued
WITH
medical
indicaNon
p-­‐value
Sex
,
n(%)
Female
Male
34(60.7)
22(39.3)
45(68.2)
21(31.8)
0.390┼
Age,
years,
mean(SD)
27.3(10.0)
26.4(11.8)
0.579*
EducaNon,
n(%)
≤
4
years
5-­‐9
years
10-­‐12
years
>12
years
2(3.8)
20(37.7)
20(37.7)
11(20.8)
6(10.2)
15(25.4)
22(37.3)
16(27.1)
0.216┼
Distance
to
CHSJ,
Km,
mean(SD)
18.3(25.7)
18.8(16.3)1
0.104*
Pathology,
n(%)
Rhini0s
Asthma
Conjunc0vi0s
55(98.2)
24(42.9)
17(30.4)
64(97.0)
25(37.9)
24(36.4)
0.772┼
Vaccine
period,
n(%)
Perannual
Pre-­‐season
43(86.0)
7(14.0)
46(82.2)
10(17.9)
0.589┼
Vaccine
type,
n(%)
Polimerizada
Depot
48(85.7)
8(14.3)
56(86.2)
9(13.8)
0.945┼
Allergen,
n(%)
Mites
Polens
34(60.7)
22(39.3)
38(58.5)
27(41.5)
0.801┼
AdministraNons,
number,
mean(SD)
13.0(8.1)
10.4(7.8)
1
0.096*
DuraNon
of
treatment,
months,
mean(SD)
10.8(8.8)
9.1(10.9)
0.061*
Immediate
reacions,
number,
mean(SD)
1.9(3.1)
1.8(3.0)
0.756*
Late
reacNons,
number,
mean(SD)
1.4(2.0)
1.5(2.9)
0.795*
Improvement
with
SCIT?,
n(%)
0.254┼
Yes
↓
symptoms
↓
need
for
medica0on
↓
ER
episodes
41(73.2)
31(75.6)
26(63.4)
5(12.2)
54(81.8)
51(94.4)
33(61.1)
14(25.9)
0.373┼
No
↑
symptoms
No
effect
15(26.8)
1(6.7)
14(93.3)
12(18.2)
2(18.2)
9(81.8)
0.364┼
Family
history
of
Allergic
Disease
n(%)
0.206┼
Yes
Treated
with
immunotherapy
No
immunotherapy
31(55.4)
7(23.3)
23(76.7)
42(66.7)
19(45.2)
23(54.8)
0.056┼
No
25(44.6)
21(33.3)
*Mann
Whitney;
┼
Chi-­‐square
1
Par0cipants
that
con0nued
SCIT
at
other
Health-­‐Care
Units
were
excluded
59%
considered
economical
factors
as
relevant
to
disconNnue
treatment
(cost
of
SCIT
or
commu-ng
difficul-es)
73%
referred
improvement
with
SCIT
77%
might
resume
treatment
Sex,
n(%)
Female
79(65)
Age,
mean
(SD)
26.8(11.0)
Distance
to
CHSJ,
mean
(SD)
21.1(25.6)
Pathology,
n(%)
Rhini0s
Asthma
Conjunc0vi0s
117(96)
49(40)
41(34)
SCIT
seasonality,
n(%)
Perannual
89(84)
Vaccine
type,
n(%)
Polymerized
104(86)
AdministraNons,
number,
mean(SD)
11.9(8.9)
Treatment
duraNon,
months,
mean(SD)
9.9(10.0)
Immediate
reacNons,
n(%)
1.9(3.0)
Late
reacNons,
n(%)
1.5(2.5)
Time
elapsed
since
ending
ofSCIT
18.4(8.8)
No
sta5s5cal
significant
differences
between
interviewed
and
non-­‐interviewed
181
Selected
Inclusion
Criteria
-­‐
Followed
at
CHSJ
-­‐
Actual
or
previous
treatment
with
ASCI
-­‐
No
record
of
ASCI
administra0on
in
the
past
3-­‐6
months
-­‐
No
indica0on
to
con0nue
ASCI
at
other
health
care
unit
122
interviewed
59
excluded
44
incorrect
phone
number/unavailable
15
did
not
answer
acer
3
adempts
Structured
telephonic
quesNonaire
-­‐
Socio-­‐demographic
caractheriza0on
-­‐
ASCI
adherence
-­‐
Reasons
to
discon0nue
-­‐
Sa0sfac0on
with
treatment
33
con0nued
ASCI
33
discon0nued
with
medical
indica0on
56
disconNnued
without
medical
indicaNon
70%
completed
treatment
5.4
3.6
5.4
5.4
39.3
0.0
8.9
5.4
26.8
26.8
20.0
21.8
25.0
57.1
25.0
25.0
12.5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ausência
de
melhoria
Reacções
adversas
Dificuldade
de
deslocação
Dificuldade
em
conciliar
horário
com
trabalho/escola
Custo
económico
da
ITSC
Custo
económico
da
deslocação
Mudança
de
residência
Mudança
de
trabalho
Outros
mo0vos
Figure
1
Reasons
for
disconNnuing
SCIT
without
medical
indicaNon
Reportado
espontaneamente
Resposta
posi0va
à
questão
específica
No
improvement
Adverse
Reac0ons
Commuong
dificul0es
Difficulty
reconciling
schedule
with
work/school
Economic
cost
Ecconomic
cost
of
commu0ng
Change
of
residence
Change
of
work
Other
reasons
Reported
spontaneously
Posi0ve
answer
to
specific
ques0on
*
NOTE:
It
was
ini-aly
asked
the
par-cipants
to
state
the
main
reason
for
discon-nuing
ASCI
(“spontaneously
reported”)
and
laHer
ques-oned
if
various
specific
factors
had
influenced
the
decision
(“posi-ve
answer
to
specific
ques-on”)
* Includes
successive
forgerulness(7.2%),
appearence
of
disease
“de
novo”(3.6%),
difficulty
in
understanding
treatment
(3.6%),
improvement/thougt
that
it
was
not
necessary
to
con0nue
(1.8%),
pregnancy
(1.8%)
and
others.
No
differences
were
seen
between
groups
that
had
conNnued
and
suspended
immunotherapy
(age,
sex,
allergy
disease,
immunotherapy
type,
adverse
reacNon,
profession,
scholarship
and
distance
from
home
to
Hospital).
Administra-on
route,
non
immediate
efficacy
and
cost
can
affect
compliance
to
subcutaneous
immunotherapy
(SCIT).
520