title: Comparison of scores associating symptoms and rescue medication use for evaluating the efficacy of allergy immunotherapy in seasonal allergic rhinoconjunctivitis: results from five trials.
abstract: BACKGROUND
  Over the past decade, regulatory bodies and scientific societies recommended, as primary efficacy outcome, a score that reflects both symptom severity and use of rescue medication for clinical trials in allergy immunotherapy (AIT).
  
  
  OBJECTIVE
  We sought to compare the results obtained with two subject-specific scores, the Combined Score (CS) and the Adjusted Symptom Score (AdSS), for assessment of AIT in seasonal allergic rhinoconjunctivitis due to birch and grass pollen allergens.
  
  
  METHODS
  CS and AdSS were evaluated in subjects receiving a 300IR dose of allergen extract daily, by sublingual route, in four clinical trials with the 5-grass pollen tablet (NCT00367640, NCT00409409, NCT00955825 and NCT00418379) and one with the birch pollen solution (NCT01731249). The CS is derived from the Rhinoconjunctivitis Total Symptom Score (RTSS) and the Rescue Medication Score (RMS) giving equal weight to symptoms and medication use. The AdSS is a symptom score adjusting for rescue medication use. Efficacy end-points were analysed using an analysis of covariance linear model.
  
  
  RESULTS
  In all trials, despite the different constructs of the two scores, Combined Score or Adjusted Symptom Score were similarly reduced in the 300IR group compared to the placebo group. Treatment effect was consistently demonstrated with both scores, CS and AdSS, used as either daily scores or average of the daily scores over the pollen season. Minor differences with the same statistical conclusions were observed between the results, leading to the same interpretation.
  
  
  CONCLUSIONS
  The two scores, combined and adjusted scores, for evaluation of clinical efficacy of AIT have led to similar results, with similar statistical conclusions and similar interpretation.
authors: INSERM 1219, University of Rouen, Rouen, France.
authors: J-M
authors: JM
authors: Grouin
authors: Clinical Research Unit Saint-Louis Lariboisière Fernand-Widal, University of Paris-Diderot, Paris, France.
authors: E
authors: E
authors: Vicaut
authors: UPRES EA 220, Clinical Research Unit, Airway Diseases Department, Foch Hospital, University of Versailles Saint-Quentin, University Paris Saclay, Suresnes, France.
authors: P
authors: P
authors: Devillier
mesh_terms: D000286:Administration, Sublingual; D000485:Allergens / Q000276:immunology; D002986:Clinical Trials as Topic; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011058:Pollen / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D063189:Symptom Assessment; D013607:Tablets; D016896:Treatment Outcome
chemical_list: D000485:Allergens; D013607:Tablets
keywords: allergic rhinoconjunctivitis; clinical immunology; immunotherapy and tolerance induction; rhinitis; sublingual immunotherapy; symptom score