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An analysis of factors associated with compliance and dropout of sublingual immunotherapy on Japanese cedar pollinosis patients
Author(s) -
Imanaka Takahiro,
Sato Izumi,
Kawasaki Yohei,
Kanazawa Yuji,
Kawakami Koji
Publication year - 2019
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22308
Subject(s) - medicine , sublingual immunotherapy , hazard ratio , confidence interval , young adult , dropout (neural networks) , demography , proportional hazards model , multivariate analysis , pediatrics , immunotherapy , sociology , cancer , machine learning , computer science
Background Sublingual immunotherapy (SLIT) is safe and effective but compliance is problematic. In this study we evaluated dropout and compliance among adults (≥20 years of age) and adolescents (<20 years of age) for Japanese cedar pollen extract (JCPE), an aqueous SLIT approved in 2014 in Japan. Methods Administrative claims data on 1236 Japanese patients, 846 adults (mean age, 43.0 years; 41.8% female) and 249 adolescents (mean age, 14.1 years; 36.6% female), with a JCPE prescription between October 2014 and June 2016 were reviewed. Adults and adolescents were divided according to the year they started SLIT (1‐ and 2‐year cohorts) to calculate dropout and compliance and identify associated factors using multivariate Cox and linear regression models. Results In 1‐ and 2‐year adult cohorts, dropout rates were 13.5% and 22.1% and compliance rates were 92.8% and 88.8%, respectively. Adolescents had higher dropout and lower compliance. Patients 40‐59 years of age had a lower dropout risk than patients 20‐29 years of age. Dropout hazard ratios (95% confidence interval) in 1‐ and 2‐year cohorts were 0.26 (0.12‐0.58) and 0.40 (0.17‐0.93) in patients 40‐49 years of age and 0.32 (0.14‐0.75) and 0.35 (0.13‐0.92) in patients 50‐59 years of age, respectively. Younger age contributed to lower compliance in 1‐ and 2‐year adult cohorts ( p = 0.001 and p = 0.02, respectively). Systemic steroidal medication history and male gender were positively associated with compliance in adults but not in adolescents. Conclusion High dropout rate was associated with younger generations. Compliance in adults, but not in adolescents, was associated with age, systemic steroidal medication history, and gender.