AIM    Describe  the  reasons  that  lead  to  discon0nuing  SCIT  without  medical  indica0on    and  compare  these  pa0ents  with  a  group  of  compliant  pa0ents.  

Reasons  for  Discon-nuing  Allergen  Subcutaneous  Immunotherapy  

Diana    Silva,  Ana  Pereira,  Natacha  Santos,  José  Luís  Plácido    Immunoallergology  Service,  Centro  Hospitalar  São  João,  EPE  -­‐  Porto,  Portugal  

22%  

17%  

8%  

8%  6%  

4%  

4%  

4%  

4%  

P

METHODS   Cross-­‐sec0onal   study   of   an   inten0onal   sample   of   pa0ents  

obtained   immunotherapy   admnistra0on   registers   from   Centro   Hospitalar   S.  

João  (CHSJ).    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RESULTS  

CONCLUSION  

Cost  was  the  main  factor  for  disconNnuing  immunotherapy.  Due  to  the  present  financial  situaNon  of  Portugal,  this  scenario  may  worsen.  

Compliance  to  the  treatment  should  be  re-­‐enforced  and  the  economical  impact  of  immunotherapy  should  be  considered  

Table  1.  ComparaNve  study  beetween  paNents  that  disconNnued  SCIT  without  medical  indicaNon  (n=56)  and  parNcipants  that  conNnued  or  disconNnued  SCIT  with  medical  indicaNon  (n=66)  

DisconNnued  WITHOUT    

medical  indicaNon  

ConNnued  OR  disconNnued  WITH  medical  indicaNon   p-­‐value  

Sex  ,  n(%)    Female  Male  

 34(60.7)  22(39.3)  

 45(68.2)  21(31.8)  

0.390┼  

Age,  years,  mean(SD)   27.3(10.0)   26.4(11.8)   0.579*  EducaNon,  n(%)  

≤  4  years  5-­‐9  years  

10-­‐12  years  >12  years  

 2(3.8)  20(37.7)  20(37.7)  11(20.8)  

 6(10.2)  15(25.4)  22(37.3)  16(27.1)  

0.216┼  

Distance  to  CHSJ,  Km,  mean(SD)   18.3(25.7)   18.8(16.3)1   0.104*  Pathology,  n(%)                                                                    

 Rhini0s  Asthma  

Conjunc0vi0s  

 55(98.2)  24(42.9)  17(30.4)  

 64(97.0)  25(37.9)  24(36.4)  

0.772┼  

Vaccine  period,  n(%)  Perannual  Pre-­‐season  

 43(86.0)  7(14.0)  

 46(82.2)  10(17.9)  

0.589┼    

Vaccine  type,  n(%)  Polimerizada  

Depot  

 48(85.7)  8(14.3)  

 56(86.2)  9(13.8)  

0.945┼    

Allergen,  n(%)  Mites  Polens  

 34(60.7)  22(39.3)  

 38(58.5)  27(41.5)  

0.801┼    

AdministraNons,  number,  mean(SD)   13.0(8.1)   10.4(7.8)  1   0.096*  DuraNon  of  treatment,  months,  mean(SD)   10.8(8.8)   9.1(10.9)   0.061*  Immediate  reacions,  number,  mean(SD)   1.9(3.1)   1.8(3.0)   0.756*  Late  reacNons,  number,  mean(SD)   1.4(2.0)   1.5(2.9)   0.795*  Improvement  with  SCIT?,  n(%)   0.254┼  

Yes  ↓  symptoms  

↓  need  for  medica0on  ↓  ER  episodes  

41(73.2)  31(75.6)  26(63.4)  5(12.2)  

54(81.8)  51(94.4)  33(61.1)  14(25.9)  

 0.373┼  

 

No  ↑  symptoms  

No  effect  

15(26.8)  1(6.7)  14(93.3)  

12(18.2)  2(18.2)  9(81.8)  

 0.364┼  

 Family  history  of  Allergic  Disease  n(%)   0.206┼  

Yes  Treated  with  immunotherapy  

No  immunotherapy  

31(55.4)  7(23.3)  23(76.7)  

42(66.7)  19(45.2)  23(54.8)  

 0.056┼  

No   25(44.6)   21(33.3)  *Mann  Whitney;  ┼  Chi-­‐square  1  Par0cipants  that  con0nued  SCIT  at  other  Health-­‐Care  Units  were  excluded  

59%  considered  economical  factors  as  relevant  to  disconNnue  treatment  

(cost  of  SCIT  or  commu-ng  difficul-es)  

73%  referred  improvement  with  SCIT  

77%  might  resume  treatment  

Sex,  n(%)    Female  

 79(65)  

Age,  mean  (SD)   26.8(11.0)  Distance  to  CHSJ,  mean  (SD)   21.1(25.6)  Pathology,  n(%)  

                                                                   Rhini0s  Asthma  

Conjunc0vi0s  

 117(96)  49(40)  41(34)  

SCIT  seasonality,  n(%)    Perannual  

 89(84)  

Vaccine  type,  n(%)                                                                                  Polymerized  

 104(86)  

AdministraNons,  number,  mean(SD)  

11.9(8.9)  

Treatment  duraNon,  months,  mean(SD)  

9.9(10.0)  

Immediate  reacNons,  n(%)   1.9(3.0)  Late  reacNons,  n(%)   1.5(2.5)  Time  elapsed  since  ending  ofSCIT   18.4(8.8)  

No  sta5s5cal  significant  differences  between  interviewed  and  non-­‐interviewed    

181  Selected  

Inclusion  Criteria  -­‐   Followed    at  CHSJ  -­‐   Actual  or  previous  treatment  with  ASCI  

-­‐   No  record  of  ASCI  administra0on  in  the  past    3-­‐6  months  

-­‐   No  indica0on  to  con0nue  ASCI  at  other  health  care  unit  

122  interviewed  

59  excluded  

44  incorrect  phone  number/unavailable  

15  did  not  answer  acer  3  adempts    Structured  telephonic  quesNonaire  

-­‐  Socio-­‐demographic  caractheriza0on  

-­‐  ASCI  adherence  

-­‐   Reasons  to  discon0nue  -­‐   Sa0sfac0on  with  treatment  

33  con0nued  ASCI  

33  discon0nued  with  medical  indica0on  

56  disconNnued  without  medical  

indicaNon  

70%  completed  treatment  

5.4  

3.6  

5.4  

5.4  

39.3  

0.0  

8.9  

5.4  

26.8  

26.8  

20.0  

21.8  

25.0  

57.1  

25.0  

25.0  

12.5  

0%   10%   20%   30%   40%   50%   60%   70%   80%   90%   100%  

Ausência  de  melhoria  

Reacções  adversas  

Dificuldade  de  deslocação  

Dificuldade  em  conciliar  horário  com  trabalho/escola  

Custo  económico  da  ITSC  

Custo  económico  da  deslocação  

Mudança  de  residência  

Mudança  de  trabalho  

Outros  mo0vos  

Figure  1  Reasons  for  disconNnuing  SCIT  without  medical  indicaNon    

Reportado  espontaneamente  Resposta  posi0va  à  questão  específica  

No  improvement    

Adverse  Reac0ons    

Commuong  dificul0es    

Difficulty  reconciling  schedule  with  work/school  

 Economic  cost  

 Ecconomic  cost  of  commu0ng  

 Change  of  residence  

 Change  of  work  

 Other  reasons  

Reported  spontaneously  Posi0ve  answer  to  specific  ques0on  

*

NOTE:  It  was  ini-aly  asked  the  par-cipants  to  state  the  main  reason  for  discon-nuing  ASCI  (“spontaneously  reported”)  and  laHer  ques-oned  if    various  specific  factors  had  influenced  the  decision  (“posi-ve  answer  to  specific  ques-on”)    

* Includes  successive  forgerulness(7.2%),  appearence  of  disease  “de  novo”(3.6%),  difficulty  in  understanding  treatment  (3.6%),  improvement/thougt  that  it  was  not  necessary  to  con0nue  (1.8%),  pregnancy  (1.8%)  and  others.  

No  differences  were  seen  between  groups  that  had  conNnued  and  suspended  

immunotherapy  (age,  sex,  allergy  disease,  immunotherapy  type,  adverse  

reacNon,  profession,  scholarship  and  distance  from  home  to  Hospital).  

Administra-on  route,  non  immediate  efficacy  and  cost  can  affect  compliance  to  subcutaneous  immunotherapy  (SCIT).  

520