Assessment of measurement-based care to improve outcomes in patients with allergic rhinitis in an open-label, prospective study

Authors

  • Anne K. Ellis, MD, MSc, FRCPC Division of Allergy & Immunology, Department of Medicine, Queen’s University, Kingston, ON
  • Paul K. Keith, MD, FRCPC Division of Allergy and Clinical Immunology, Department of Medicine, McMaster University, Hamilton, ON
  • Jean-Nicolas Boursiquot, MD, FRCPC Department of Medicine, Laval University, Québec, QC
  • Bruno Francoeur, MD CIC Mauricie, Trois-Rivières, QC
  • Amin Kanani, MD, FRCPC Division of Allergy & Immunology, Department of Medicine, University of British Columbia, Vancouver, BC

DOI:

https://doi.org/10.58931/cpct.2023.1S0511

Abstract


Background

Despite available treatments for allergic rhinitis (AR), patients are often dissatisfied with their treatment and experience uncontrolled symptoms. Measurement-based care is the systematic use of standardized measurements used during office visits to inform treatment decisions. The Improving Symptom Control of Allergic Rhinitis (ICAR) study determined if the assessment and management of AR through measurement-based care could improve patient outcomes.

Methods

ICAR was a real-world, open-label, prospective, multicenter study conducted in Canada between September 2021 and December 2021. Enrolled adult patients (n=503) with AR were categorized as treatment-naïve, uncontrolled despite AR treatment, or requiring a treatment switch due to adverse effects. AR symptoms and symptom control were assessed by the patient using the Rhinitis Control Assessment Test (RCAT) and, by both the patient and the clinician, on a visual analog scale (VAS) at baseline and after 4 weeks of 10 mg daily oral rupatadine.

Results

The majority of patients were uncontrolled (36%) or partially controlled (51%) at baseline, while 20% were treatment-naïve, 32% were uncontrolled despite treatment, and 30% needed treatment switch.
At baseline, 66% of patients were taking non-sedating antihistamines, and 78% indicated they were dissatisfied with their treatment.

The overall RCAT score improved by 66%, from an average standard deviation (SD) of 16 (5.2) at baseline to 24 (3.8) at follow-up (P<0.0001). Scores for all individual RCAT items significantly improved (P<0.0001), with a 65% improvement in congestion frequency, a 61% improvement in sneezing frequency, and a 68% improvement in symptom control. Overall RCAT scores significantly improved from baseline by 67% in treatment-naïve patients; 64% in patients uncontrolled despite treatment; 51% in patients needing treatment switch; 55% in patients with asthma; 62% in patients with urticaria; 54% in patients with eczema/atopic dermatitis; 40% in patients with nasal polyps; and 52% in patients with no comorbidities (P<0.0001).

The patient VAS score improved from a mean SD of 6.5 (2.4) units at baseline to 2.6 (2.2) at follow-up; the clinician VAS score improved from 6.6 (2.2) units to 2.0 (2.2).

Conclusion

The ICAR study demonstrated that rupatadine, an antihistamine that also has anti-platelet-activating factor effects, significantly improves AR symptom control when used daily and monitored objectively by measurement-based care.

Author Biographies

Anne K. Ellis, MD, MSc, FRCPC, Division of Allergy & Immunology, Department of Medicine, Queen’s University, Kingston, ON

Dr. Anne K. Ellis is a Professor of Medicine and Chair of the Division of Allergy & Immunology at Queen’s University. She holds the James H. Day Chair in Allergic Diseases and Allergy Research. She is the Director of the Environmental Exposure Unit and the Allergy Research Unit at Kingston General Hospital. She is the current Vice President of the Canadian Society of Allergy and Clinical Immunology and serves on the Joint Task Force for Practice Parameters, representing the American College of Allergy, Asthma, and Immunology.

Paul K. Keith, MD, FRCPC, Division of Allergy and Clinical Immunology, Department of Medicine, McMaster University, Hamilton, ON

Dr. Paul Keith is a Professor of Medicine and Director in the Division of Clinical Immunology and Allergy at McMaster University in Hamilton, ON.

Jean-Nicolas Boursiquot, MD, FRCPC, Department of Medicine, Laval University, Québec, QC

Dr. Jean-Nicolas Boursiquot completed his medical degree and internal medicine specialty at Université Laval. He then completed postdoctoral training in clinical immunology and allergy at McGill University. He holds a Master's degree in Biomedical Sciences from the University of Montreal and is currently working as an allergist and clinical immunologist at the CHU de Québec, where he also teaches residents in the allergy and immunology program. He was director of the Continuing Professional Development Committee of the Québec Association of Allergists and Immunologists. In 2016, he participated in the adaptation of the ‘’Guide complet des allergies’’ published by Éditions Edito.

Bruno Francoeur, MD, CIC Mauricie, Trois-Rivières, QC

Dr. Bruno Francoeur is a general practitioner practicing in Trois-Rivières, Québec. He recently joined Syneos Health as an Executive Medical Director. His background includes expertise in family medicine, respiratory disease evaluation (asthma/COPD), evaluation of allergy tests, urticaria evaluation and clinical research. Since 2016, he has participated in numerous phase II to phase IV studies as an investigator, co-investigator and/or assistant medical director. He has also supervised residents during his family medicine internship, while working as an emergency physician.

Amin Kanani, MD, FRCPC, Division of Allergy & Immunology, Department of Medicine, University of British Columbia, Vancouver, BC

Dr. Amin Kanani is a Clinical Associate Professor in Medicine at the University of British Columbia and the Head of the Division of Allergy and Clinical Immunology at St. Paul’s Hospital and University of British Columbia. Dr. Kanani completed his medical degree at McGill University. He then went on to complete Internal Medicine training at UBC and Clinical Immunology and Allergy fellowship training at the University of Toronto. He has held several leadership positions including President of the BC Society of Allergy and Immunology, Board of Directors for the Canadian Hereditary Angioedema Society, and Interim Program Director for the UBC Allergy and Clinical Immunology training program. His clinical and research interests include chronic urticaria, hereditary angioedema and primary immunodeficiency.

References

Meltzer EO, Blaiss MS, Naclerio RM, Stoloff SW, Derebery MJ, Nelson HS, et al. Burden of allergic rhinitis: Allergies in America, Latin America, and Asia-Pacific adult surveys. Allergy Asthma Proc. 2012;33 Suppl 1:S113-41. DOI: https://doi.org/10.2500/aap.2012.33.3603

Meltzer EO, Farrar JR, Sennett C. Findings from an online survey assessing the burden and management of seasonal allergic rhinoconjunctivitis in US patients. The Journal of Allergy and Clinical Immunology: In Practice. 2017 May 1;5(3):779-89. DOI: https://doi.org/10.1016/j.jaip.2016.10.010

Keith PK, Desrosiers M, Laister T, Schellenberg RR, Waserman S. The burden of allergic rhinitis (AR) in Canada: perspectives of physicians and patients. Allergy, Asthma & Clinical Immunology. 2012 Dec;8(1):1-1. DOI: https://doi.org/10.1186/1710-1492-8-7

Cingi C, Gevaert P, Mösges R, Rondon C, Hox V, Rudenko M, Muluk NB, Scadding G, Manole F, Hupin C, Fokkens WJ. Multi-morbidities of allergic rhinitis in adults: European acad- emy of allergy and clinical immunology task force report. Clinic- al and Translational Allergy. 2017 Dec;7(1):1-2. DOI: https://doi.org/10.1186/s13601-017-0153-z

Church MK, Máspero JF, Maurer M, Ryan D, Canonica GW, Baena-Cagnani CE. The scope of pharmacological and clinical effects of modern antihistamines, with a special focus on rupatadine: proceedings from a satellite symposium held at the 21st World Allergy Congress, Buenos Aires, December 8, 2009. The World Allergy Organization Journal. 2010 Apr;3(Suppl 1):S1. DOI: https://doi.org/10.1186/1939-4551-3-S1-S1

Rosenwasser L. New insights into the pathophysiology of allergic rhinitis. Allergy and Asthma Proceedings. 2007;28:10-5. DOI: https://doi.org/10.2500/aap.2007.28.2977

Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bos- nic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140:950-8. DOI: https://doi.org/10.1016/j.jaci.2017.03.050

Hossenbaccus L, Linton S, Garvey S, Ellis AK. Towards definitive management of allergic rhinitis: best use of new and estab- lished therapies. Allergy, Asthma & Clinical Immunology. 2020 Dec;16(1):1-7. DOI: https://doi.org/10.1186/s13223-020-00436-y

Small P, Keith PK, Kim H. Allergic rhinitis. Allergy, Asthma & Clin- ical Immunology. 2018 Sep;14(2):1-1. DOI: https://doi.org/10.1186/s13223-018-0280-7

Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, Ellis AK, Finegold I, Golden DB, Greenhawt MJ. Rhinitis 2020: a practice parameter update. Journal of Al- lergy and Clinical Immunology. 2020 Oct 1;146(4):721-67. DOI: https://doi.org/10.1016/j.jaci.2020.07.007

Jeffrey J, Klomhaus A, Enenbach M, Lester P, Krishna R. Self-re- port rating scales to guide measurement-based care in child and adolescent psychiatry. Child and Adolescent Psychiatric Clinics. 2020 Oct 1;29(4):601-29. DOI: https://doi.org/10.1016/j.chc.2020.06.002

Aboraya A, Nasrallah HA, Elswick DE, Ahmed E, Estephan N, Aboraya D, et al. Measurement-based Care in Psychiatry-Past, Present, and Future. Innov Clin Neurosci. 2018;15:13-26.

Higdon C, Blader J, Kalari VK, Fornari VM. Measurement-Based Care in the Treatment of Attention-Deficit/Hyperactivity Disorder and Disruptive Behavior Disorders. Child and Adolescent Psychiatric Clinics. 2020 Oct 1;29(4):663-74. DOI: https://doi.org/10.1016/j.chc.2020.06.005

Waldrop J, McGuinness TM. Measurement-based care in psychiatry. Journal of Psychosocial Nursing and Mental Health Services. 2017 Nov 1;55(11):30-5. DOI: https://doi.org/10.3928/02793695-20170818-01

Meltzer EO, Schatz M, Nathan R, Garris C, Stanford RH, Kosinski M. Reliability, validity, and responsiveness of the Rhinitis Control Assessment Test in patients with rhinitis. Journal of Allergy and Clinical Immunology. 2013 Feb 1;131(2):379-86. DOI: https://doi.org/10.1016/j.jaci.2012.10.022

Simons FE, Simons KJ. Histamine and H1-antihistamines: celebrating a century of progress. Journal of Allergy and Clinical Immunology. 2011 Dec 1;128(6):1139-50. DOI: https://doi.org/10.1016/j.jaci.2011.09.005

Muñoz-Cano RM, Casas-Saucedo R, Valero Santiago A, Bobolea I, Ribó P, Mullol J. Platelet-activating factor (PAF) in allergic rhinitis: clinical and therapeutic implications. Journal of Clinical Medicine. 2019 Aug 29;8(9):1338. DOI: https://doi.org/10.3390/jcm8091338

Wong MM, Keith PK. Presence of positive skin prick tests to inhalant allergens and markers of T2 inflammation in subjects with chronic spontaneous urticaria (CSU): a systematic literature review. Allergy, Asthma & Clinical Immunology. 2020 Aug 4;16(1):72. DOI: https://doi.org/10.1186/s13223-020-00461-x

Keith PK, Luciuk G. Effectiveness of desloratadine 5 mg once daily in patients with symptoms of seasonal allergic rhinitis: results of a Canadian multicenter, open-label trial. Clinical Therapeutics. 2007 Mar 1;29(3):419-26. DOI: https://doi.org/10.1016/S0149-2918(07)80080-4

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Published

2023-05-25

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Ellis AK, Keith PK, Boursiquot J-N, Francoeur B, Kanani A. Assessment of measurement-based care to improve outcomes in patients with allergic rhinitis in an open-label, prospective study. Can Prim Care Today [Internet]. 2023 May 25 [cited 2024 Nov. 21];1(S05). Available from: https://canadianprimarycaretoday.com/article/view/1-s2-ellis_et_al

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