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Allergy summitv2018

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WG Minutes REG Summit 2018

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Allergy summitv2018

  1. 1. REG Summit 2018 Amsterdam, 22nd March 2018 Allergy Working Group Meeting
  2. 2. Agenda • Working group progress update • Proposals for potential studies o Review potential studies – Presentation and treatment of chronic rhinosinusitis in the UK – Cumulative steroid exposure – The effect of sinus surgery on asthma o Support, funding and logistics • Areas of future research • Additional items
  3. 3. Attendees • Sven Seys (Chair)
  4. 4. Progress update • Active studies o Assess the incidence of acute chronic rhinosinusitis o Australian survey of allergic rhinitis sufferers
  5. 5. Active study update: Quantify the burden of acute versus chronic rhinosinusitis in routine clinical practice • Objective: o Quantify the burden of rhinitis and rhinosinusitus and characterize related management approaches in UK primary care • Methods: o Retrospective database study using OPCRD • Conclusion: o Acute rhinosinusitis consultations make up 35% of all primary care consultations for rhinitis and rhinosinusitis o 71% consulting for acute rhinosinusitis and 58% for chronic rhinosinusitis receive an antibiotic prescription • Status: o Paper in draft format (Prof. Fokkens)
  6. 6. Australian Survey of Allergic Rhinitis Sufferers (REG-RES1615) • Objective: o To build and disseminate a comprehensive picture of the burden and unmet need of allergic rhinitis patients in Australia. • Methods: o Online survey with discrete choice experiment with patients recruited through specialist recruitment agency • Conclusions: o 88% used medication to treat their AR; 80% use more than one medication o Two thirds of participants see a doctor or specialist for their AR o Only 13% of participants had received immunotherapy for their AR o Patients showed a preference for treatments providing complete relief and taken once a day instead of more frequently. No preference was shown between tablets and nasal spray compared to nasal spray alone. • Status: o Final report complete
  7. 7. Proposals for potential projects • Presentation and treatment of chronic rhinosinusitis in the UK • The burden of steroid use in multimorbid patients • The effect of sinus surgery on asthma • Prevalence of urticaria and unmet needs
  8. 8. The presentation and treatment of CRS in primary care in the UK • Objective: o Build on the “rhinosinusitis burden” project to provide a detailed description of treatment paths, time to treatment change and the effects of comorbidities on presentation and treatment. • Rationale: o With the introduction of novel therapeutics, and the potential of personalised medicine, it is important to understand the underlying disease presentation, clinical practice and the interplay of comorbidities with symptoms and control.
  9. 9. The presentation and treatment of CRS in primary care in the UK • Proposed methodology: o Retrospective observational study of patient in the OPCRD with CRS o The majority of the analysis will be descriptive o Impact of comorbidities evaluated using cross-sectional design Population Patients in the OPCRD with Read codes suggestive of CRS Exploratory outcomes Number of CRS consultations Symptoms Changes to medication Sinus surgery Clinical investigations Comorbidities Atopy Sub-analysis CRS patients with comorbid asthma
  10. 10. The burden of steroid use in multimorbid patients Question: Does this complement or duplicate work currently in progress? • Objective: o Quantify the burden of steroid use in patients with allergic rhinitis (AR), CRS and asthma • Rationale: o Those with AR or CRS may have a greater risk of asthma and other allergic diseases o These diseases are often treated with steroids; which while effective may be associated with local or systemic adverse events
  11. 11. • Proposed methodology: o Retrospective cohort study of patient in the OPCRD with CRS The burden of steroid use in multimorbid patients Exposure Increase in steroid exposure Primary outcomes Changes in BMI Incidence and time to diabetes diagnosis Progression to insulin in diabetics New steroid-related conditionsSub-analyses CRS vs. asthma+CRS CRS vs. CRS+atopic dermatitis CRS vs. CRS+AR CRS vs. CRS+other allergic conditions Dose-response of steroid exposure Population Patients in the OPCRD with Read codes suggestive of CRS receiving low dose steroids
  12. 12. The effects of sinus surgery on patients with CRS and asthma • Objective: o Define the real-life effectiveness of sinus surgery in CRS patients, determine the incidence of novel asthma diagnosis following sinus surgery and evaluate the effect of sinus surgery on pre-existing asthma • Rationale: o Sinus surgery improves quality of life, decrease absenteeism and be a cost-effective alternative to medical management. Small studies have shown an associated improvement in asthma symptoms.
  13. 13. The effects of sinus surgery on patients with CRS and asthma • Proposed methodology: o Retrospective cohort study of patient in the OPCRD with CRS – Preliminary data shows 3,632 patients with a Read code for sinus surgery and a year of continuous EMR prior and after index
  14. 14. The effects of sinus surgery on patients with CRS and asthma • Main analysis • Sub-analysis Population Patients in the OPCRD with Read codes suggestive of CRS Exposure Read code for sinus surgery Primary outcomes Number of CRS consultations Prescriptions for CRS drugs Change in disease status of comorbidities Novel asthma diagnosis Population Patients in the OPCRD with Read codes suggestive of CRS and with asthma diagnosis Exposure Read code for sinus surgery Primary outcomes Asthma exacerbations GINA step SABA usage Asthma control Asthma quality of life
  15. 15. Prevalence of urticaria and unmet needs • Proposed by Marcus Maurer and Dermot Ryan • Proposed methodology: o Retrospective database study Primary outcomes Prevalence of urticaria Prevalence of chronic urticarial Prescribing patterns Estimation of unmet needs Referrals to secondary care Population Patients in the OPCRD with Read codes suggestive of urticaria
  16. 16. Push projects forwards • Who will conduct these studies? • What support can REG provide? • How will we secure funding, and who should be approached?
  17. 17. Other research ideas?
  18. 18. Any other business?

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