title: Treatment effect of sublingual immunotherapy tablets and pharmacotherapies for seasonal and perennial allergic rhinitis: Pooled analyses.
abstract: Data comparing the treatment effect of allergy immunotherapy and pharmacotherapy are lacking.
  
  
  
  We sought to indirectly compare the treatment effect of sublingual immunotherapy (SLIT)-tablets with pharmacotherapy for seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR).
  
  
  
  Pooled data from randomized, double-blind, placebo-controlled trials for the clinical development programs of selected allergic rhinitis treatments were evaluated. Total nasal symptom scores (TNSSs) relative to placebo were compared. Subjects scored symptoms daily during entire pollen seasons in 6 timothy grass SLIT-tablet trials (n = 3094) and 2 ragweed SLIT-tablet trials (n = 658) and during the last 8 weeks of treatment in 2 house dust mite (HDM) SLIT-tablet trials (n = 1768). Subjects scored symptoms daily in 7 montelukast (10 mg, n = 6799), 9 desloratadine (5 mg, n = 4455), and 8 mometasone furoate nasal spray (MFNS; 200 μg daily, n = 2140) SAR or PAR trials. SLIT-tablet trials allowed rescue medication use, whereas most pharmacotherapy trials did not. A fixed-effect meta-analysis method estimated differences in on-treatment average TNSSs.
  
  
  
  In grass and ragweed SLIT-tablet trials, overall improvement in TNSSs relative to placebo was 16.3% and 17.1%, respectively. In HDM SLIT-tablet trials, TNSS overall improvement relative to placebo was 16.1%. In the montelukast, desloratadine, and MFNS trials, TNSS overall improvement relative to placebo was 5.4%, 8.5%, and 22.2%, respectively, for SAR trials, and 3.7%, 4.8%, and 11.2%, respectively, for PAR trials.
  
  
  
  Although comparisons were limited by study design heterogeneity and use of rescue medications in SLIT-tablet trials, effects on nasal symptoms with timothy grass and ragweed SLIT-tablets were nearly as great as with MFNS and numerically greater than with montelukast and desloratadine for SAR. HDM SLIT-tablet effects were numerically greater than all pharmacotherapies for PAR. SLIT-tablets offer the additional benefit of long-term efficacy.
authors.affiliation: Royal Brompton and Harefield Hospitals National Health Service Trust and Imperial College, London, United Kingdom.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Durham
authors.affiliation: Creticos Research Group and Division of Allergy & Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Creticos
authors.affiliation: National Jewish Health, Denver, Colo.
authors.forename: Harold S
authors.initials: HS
authors.lastname: Nelson
authors.affiliation: Merck & Co, Kenilworth, NJ.
authors.forename: Ziliang
authors.initials: Z
authors.lastname: Li
authors.affiliation: Merck & Co, Kenilworth, NJ.
authors.forename: Amarjot
authors.initials: A
authors.lastname: Kaur
authors.affiliation: Allergy & Asthma Medical Group & Research Center, San Diego, Calif.
authors.forename: Eli O
authors.initials: EO
authors.lastname: Meltzer
authors.affiliation: Merck & Co, Kenilworth, NJ. Electronic address: hendrik.nolte@merck.com.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Nolte
mesh_terms: D031164:Ambrosia / Q000276:immunology; D018926:Anti-Allergic Agents / Q000008:administration & dosage; D006801:Humans; D017336:Loratadine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000068656:Mometasone Furoate / Q000008:administration & dosage*; D031784:Phleum / Q000276:immunology; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy* / Q000276:immunology / Q000628:therapy; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy* / Q000276:immunology; D063729:Sublingual Immunotherapy; D013607:Tablets / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018926:Anti-Allergic Agents; D013607:Tablets; D000068656:Mometasone Furoate; D017336:Loratadine; C121345:desloratadine
keywords: Allergen immunotherapy; allergic rhinoconjunctivitis; antihistamine; grass; house dust mite; intranasal corticosteroid; leukotriene receptor antagonists; meta-analysis; ragweed; sublingual immunotherapy tablet