Impact of Adverse Event Solicitation on the Safety Profile of SQ House Dust Mite Sublingual Immunotherapy Tablet

Publication date: Available online 10 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Hendrik Nolte, David I. Bernstein, Gordon L. Sussman, Bodil Svanholm Fogh, Susan Lu, Bernt Husøy, Harold S. Nelson
BackgroundIt has been recommended that sublingual immunotherapy (SLIT) safety be assessed using solicited adverse event (AE) collection methods.ObjectivesTo describe the impact on the safety profile of SQ house dust mite (HDM) SLIT-tablet (12 SQ-HDM dose) when pre-specified local application site reactions were solicited vs unsolicited, and discuss ramifications of AE solicitation.MethodsSubjects were randomized to daily 12 SQ-HDM or placebo for up to 52 weeks in 4 double-blinded, multicenter trials. In one trial (NCT01700192; N=1,272), subjects documented daily the presence or absence of 15 World Allergy Organization-defined local application site reactions using a structured questionnaire of closed-ended questions (solicited AEs). Subjects in the other trials were not asked about specific AEs (unsolicited AEs) and AE data were pooled (N=1,287). Analysis was limited to adults aged 18-65 years.ResultsWhether AEs were solicited or unsolicited, the most common AEs leading to study discontinuation with 12 SQ-HDM were throat irritation and oral pruritus. Approximately 95% of treatment-related AEs were mild-to-moderate. Placebo-subtracted frequencies of local application site reactions associated with 12 SQ-HDM were higher when solicited vs unsolicited (i.e., throat irritation, 46% vs 13%, respectively; oral pruritus, 47% vs 17%; ear pruritus, 40% vs 4%; mouth swelling, 8% vs 2%; tongue ulceration, 10% vs 0%; mouth ulceration, 7% vs <1%).ConclusionsQualitatively, the safety profile of 12 SQ-HDM was similar when AEs were solicited vs unsolicited; hence, solicitation did not alter the safety profile. Higher observed frequencies of local application site reactions with AE solicitation may be partly due to suggestive reporting bias, as observed in placebo-treated subjects.