An analysis of factors associated with compliance and dropout of sublingual immunotherapy on Japanese cedar pollinosis patients

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.

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