TABLE IX.D.4-1.
Evidence for the use of SLIT in the treatment of allergic rhinitis—systematic reviews and meta-analyses from the last decade
Study | Year | LOE | Study design | Study groups | Clinical endpoint | Conclusiona |
---|---|---|---|---|---|---|
Di Bona et al.815 | 2015 | 1a | Meta-analysis of RCTs | SLIT grass pollen tablets vs placebo for SAR | Symptom and medication score | Small improvement in symptom and medication scores vs placebo: (SMD −0.28; 95% CI, −0.37 to −0.19; p < 0.001) and (SMD −0.24; 95% CI, −0.31 to −0.17; p < 0.001). Adverse events: 7/2259 SLIT patients were given epinephrine. |
Leatherman et al.1692 | 2015 | 1a | Systematic review of RCTs for SLIT doses | SLIT for AR vs placebo | Doses of the effective vs doses of non-effective SLIT | Wide dose ranges between studies. For certain antigens, effective and non-effective dose ranges often overlap. For other allergens: insufficient data. |
Devillier et al.1332 | 2014 | 1a | Meta-analysis of RCTs | Pollen SLIT vs pharmacotherapy vs placebo for SAR | Relative clinical impactb | Clinical impact: 5-grass pollen tablet > INCS > Timothy grass pollen tablet > montelukast > antihistamines |
Makatsori et al.1693 | 2014 | 1a | Systematic review of RCTs | SLIT vs placebo | Drop-out rates in SLIT and placebo groups | No tendency for a skewed dropout ratio between SLIT and placebo groups. Confirms trial results are unbiased and SLIT appears to be safe. |
Lin et al.1694 | 2013 | 1a | Systematic review of RCTs | Aqueous SLIT vs placebo for SAR (and asthma) | Symptom and medication scores | Moderate evidence aqueous SLIT reduces symptoms and medication use in AR/ARC. |
Meadows et al.1617 | 2013 | 1a | Meta-analysis of RDBPCTs, cost analysis | SCIT and SLIT vs placebo for SAR | Several efficacy variables, costs | Symptom reduction with SCIT and SLIT is greater than placebo. |
Di Bona et al.1696 | 2011 | 1a | Meta-analysis of RDBPCTs | Grass pollen SLIT vs placebo for SAR (and asthma) | Symptom and medication scores | SLIT vs placebo: Reduction in symptoms (SMD −0.32) and medication use (SMD −0.33). No epinephrine use. |
Radulovic et al.1695 | 2011 | 1a | Meta-analysis of RDBPCTs | SLIT vs placebo for AR | Symptom and medication scores | SLIT vs placebo: Reduction in symptoms (SMD −0.49) and medication use (SMD −0.32). No epinephrine use. |
Durham et al.1673 | 2016 | 1b | Pooled analysis from RCTs | SAR: grass or ragweed SLIT tablet vs pharmacotherapy. PAR: HDM SLIT tablet vs pharmacotherapy. |
Total Nasal Symptom Score | SAR: SLIT numerically greater than montelukast and antihistamine; almost equal to mometasone furoate INCS. PAR: SLIT effect numerically greater than all pharmacotherapy. |
Maloney et al.1675 | 2015 | 1b | Pooled analysis from RCTs | Grass SLIT tablet vs placebo. Grass SLIT in AR patients with (24%) and without (76%) mild asthma. | Treatment related AE frequency | Severe asthma-related adverse events due to treatment in 6/120 SLIT and 2/60 placebo. No difference between the 2 groups. Both adults and children were included. |
Creticos et al.1676 | 2016 | 2a | Systematic review | Patients treated with SLIT, started in-season, vs out-of-season vs placebo | Serious treatment-related AE, systemic AE discontinuations | 11 SLIT trials (n = 2668 subjects total). No epinephrine administration. 0% to 4% systemic AE with in-season vs 0% out-season initiation. 2 serious treatment-related AE with co-season SLIT initiation. |
Oykhman et al.1677 | 2015 | 3a | Systematic review of cohort studies | Pregnant women with vs without SLIT or SCIT and their offspring. 422 pregnancies continuing AIT and 31 starting AIT. | Pregnancy outcome, allergy in offspring | No difference in prematurity, proteinuria, hypertension, congenital malformations, perinatal death. No fetal complications of 10/453 systemic reactions to SCIT. No altered risk of developing atopic disease in offspring. |
SLIT or SCIT: children only | ||||||
Larenas-Linnemann et al.1671 | 2013 | 2a | Systematic review of RCTs | Children with AR and/or asthma treated with SLIT vs placebo/open controls | Symptom and medication scores | Strong evidence that grass pollen SLIT in children reduces symptoms of AR. Moderate-low evidence for HDM SLIT. |
Roder et al.1670 | 2008 | 2a | Systematic review of RCTs | Children 0–18 years with AR: any form of AIT vs placebo | Symptom and medication scores | Insufficient evidence that AIT in any form has a positive effect on AR in children. |
SLIT vs SCIT | ||||||
Chelladurai et al.1697 | 2013 | 1a | Systematic review of RCT | SCIT vs SLIT (and vs placebo) in AR | Symptom and medication scores | Low grade evidence favors SCIT over SLIT for AR symptom and medication reduction. Moderate evidence for nasal and eye symptom reduction. |
Di Bona et al.1698 | 2012 | 1a | Meta-analysis based comparison | Grass pollen SCIT; placebo vs grass pollen SLIT; placebo in SAR | SMD of symptom and medication scores | SCIT more effective than SLIT (drops) and SLIT (tablet) for symptom and medication score reduction. |
Nelson et al.1699 | 2015 | 1b | Network meta-analysis of RCTs | Grass pollen SLIT tablets vs placebo. Grass pollen SLIT drops vs placebo. Grass pollen SCIT vs placebo. | Symptom and medication scores | Symptom and medication scores with SCIT, SLIT tablets and drops all reduced vs. placebo, except for symptom score with SLIT drops. |
Aasbjerg et al.1700 | 2015 | 2a | Systematic review of RCTs, product information, registry | AR patients receiving Phleum pratense SCIT, SLIT drops, or SLIT tablets vs placebo. (including 314 children.) | Safety data | Many products without structured collection of safety data. General safety assessment: SLIT safer than SCIT. |
Dranitsaris and Ellis1701 | 2014 | 2a | Systematic review of RCTs and indirect comparison | Timothy grass tablet, 5-grass tablet, grass pollen SCIT vs placebo in SAR | Efficacy, safety, cost for Canadian setting | Symptoms: all IT treatments better than placebo. Costs for 5-grass tablet greater than costs for Timothy grass tablet and SCIT. |
Calderon et al.1702 | 2013 | 2a | Systematic review of RCTs | Patients allergic to HDM, with AR and asthma, treated with HDM SCIT vs SLIT vs placebo | Symptom score, IT schedule, dosing | Improved symptom score vs placebo was observed more frequently for SCIT. Data is weak as the basic treatment parameters vary widely. |
Dretzke et al.1703 | 2013 | 2a | Systematic review of RCT and indirect comparison | SCIT and aqueous SLIT vs placebo, SCIT vs SLIT in AR | Symptom and medication scores | Trend favoring SCIT over SLIT for AR symptom and medication score reduction. No conclusive results. |
SLIT vs SCIT: children only | ||||||
Kim et al.1672 | 2013 | 2a | Systematic review of RCTs and indirect comparison | Children with SAR (asthma): Aqueous SLIT vs SCIT vs placebo for SAR (and asthma) | Symptom and medication scores | In children, moderate evidence that SLIT improves AR symptoms and medication use, low evidence that SCIT is superior to SLIT for both outcomes. |
Hoeks et al.1704 | 2008 | 2a | Systematic review of RCTs | SLIT vs placebo in children with asthma/ARC | Symptom and medication scores | Not enough evidence because of poor quality of the studies. |
Only outcomes with statistically significance are mentioned here.
Clinical impact score = season-long nasal or total symptom scores: 100 × (scorePlacebo – scoreActive)/scorePlacebo.
AE = adverse event; AIT = allergen immunotherapy; AR = allergic rhinitis; ARC = allergic rhinoconjunctivitis; CI = confidence interval; HDM = house dust mite; INCS = intranasal corticosteroid; LOE = level of evidence; PAR = perennial allergic rhinitis; RCT = randomized controlled trial; RDBPCT = randomized double-blind placebo-controlled trial; SAR = seasonal allergic rhinitis; SCIT = subcutaneous immunotherapy; SLIT = sublingual immunotherapy; SMD = standardized mean difference.