Catalytic Health

3 Special Supplement, May 2023 • Canadian Allergy & Immunology Today A S S E S S M E N T O F M E A S U R E M E N T- B A S E D C A R E T O I M P R O V E O U T C O M E S I N PAT I E N T S W I T H A L L E R G I C R H I N I T I S I N A N O P E N - L A B E L , P R O S P E C T I V E S T U D Y Anne K. Ellis, MD, MSc, FRCPC • Paul K. Keith, MD, FRCPC • Jean-Nicolas Boursiquot, MD, FRCPC • Bruno Franc ur, MD • Amin Kanani, MD, FRCPC B A C K G R O U N D Allergic rhinitis (AR) is a common disease characterized by symptoms of nasal congestion, runny nose, sneezing, itchy/watery eyes, and cough. These symptoms can be extremely bothersome to patients, interfering with daily activities, work and sleep, as well as negatively affecting mental health. 1-3 In addition, patients with AR tend to present with comorbid allergic diseases such as asthma, eczema/atopic dermatitis and nasal polyps. 3,4 The symptoms of AR are the result of a cascade of IgE-mediated events that occur upon exposure to an allergen to which the patient is sensitized. In the early phase of the cascade, the allergen cross-links IgE on the surface of effector cells, triggering the release of immune mediators including histamine, platelet-activating factor (PAF), prostaglandins, and leukotrienes. 5,6 Therefore, first- line treatments for AR include antihistamines (either over-the-counter [OTC] or prescription) and nasal corticosteroids. 7-9 Due to their superior safety profile, A B S T R A C T 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.

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