Adherence to Treatment in Allergic Rhinitis During the Pollen Season in Europe: A MASK‐air Study
Bernardo Sousa‐Pinto, Elı́sio Costa, Rafael José Vieira, Ludger Klimek, Wienczyslawa Czarlewski, Oliver Pfaar, Anna Bedbrook, Rita Amaral, Luisa Brussino, Violeta Kvedarienė, Désirée Larenas‐Linnemann, Tomohisa Iinuma, N. Pham‐Thi, Frederico S. Regateiro, Luís Taborda‐Barata, Maria Teresa Ventura, Ignacio J. Ansotegui, Karl‐Christian Bergmann, Giorgio Walter Canonica, Victória Cardona, Lorenzo Cecchi, Iván Chérrez-Ojeda, Cemal Cingi, Ãlvaro A. Cruz, Stefano Del Giacco, Philippe Devillier, Wytske J. Fokkens, Bilun Gemicioğlu, Tari Haahtela, Juan Carlos Ivancevich, Piotr Kuna, Helga Kraxner, Daniel Laune, Renaud Louis, Μichael Μakris, Mário Morais‐Almeida, R. Mösges, Marek Niedoszytko, Nikolaos G. Papadopoulos, Vincenzo Patella, Ana Margarida Pereira, Sietze Reitsma, Karla Robles‐Velasco, Philip W. Rouadi, Bolesław Samoliński, Milan Sova, Sanna Toppila‐Salmi, J. Sastre, Arunas Valiulis, Arzu Yorgancıoğlu, Mihaela Zidarn, Torsten Zuberbier, João Fonseca, Jean Bousquet, the MASK‐air think tank
Abstract
BACKGROUND: Adherence to rhinitis treatment has been insufficiently assessed. We aimed to use data from the MASK-air mHealth app to assess adherence to oral antihistamines (OAH), intra-nasal corticosteroids (INCS) or azelastine-fluticasone in patients with allergic rhinitis. METHODS: We included regular European MASK-air users with self-reported allergic rhinitis and reporting at least 1 day of OAH, INCS or azelastine-fluticasone. We assessed weeks during which patients answered the MASK-air questionnaire on all days. We restricted our analyses to data provided between January and June, to encompass the pollen seasons across the different assessed countries. We analysed symptoms using visual analogue scales (VASs) and the combined symptom-medication score (CSMS), performing stratified analyses by weekly adherence levels. Medication adherence was computed as the proportion of days in which patients reported rhinitis medication use. Sensitivity analyses were performed considering all weeks with at most 1 day of missing data and all months with at most 4 days of missing data. RESULTS: We assessed 8212 complete weeks (1361 users). Adherence (use of medication > 80% days) to specific drug classes ranged from 31.7% weeks for azelastine-fluticasone to 38.5% weeks for OAH. Similar adherence to rhinitis medication was found in users with or without self-reported asthma, except for INCS (better adherence in asthma patients). VAS and CSMS levels increased from no adherence to full adherence, except for INCS. A higher proportion of days with uncontrolled symptoms was observed in weeks with higher adherence. In full adherence weeks, 41.2% days reported rhinitis co-medication. The sensitivity analyses displayed similar results. CONCLUSIONS: A high adherence was found in patients reporting regular use of MASK-air. Different adherence patterns were found for INCS compared to OAH or azelastine-fluticasone that are likely to impact guidelines.