D2.195 - AIT prescription drivers: a cluster analysis of data from the CHOICE survey

While most published data on Allergen immunotherapy (AIT) focus on safety, efficacy and effectiveness of available products, little is known about the drivers of prescription of AIT, from the doctor’s point of view. The main goal of our study was to identify real-world global drivers of AIT prescription, using a cluster analysis approach.

The CHOICE study is a real-life prospective, multicenter, international, observational, cross-sectional web-based survey. We included data from 8 different geographical regions, distributed in 20 countries.  Data were collected between November 2019 and April 2024. Participating physicians completed standardized questionnaires for each AIT prescription. Based on previous CHOICE publications, thirteen clinical, patient-related, and product-related parameters possibly influencing a specific AIT selection were scored using Likert scales. Data were assessed through descriptive analysis and unsupervised cluster analysis.

We collected data from 467 physicians, prescribing AIT for a total of 11,550 patients. The main clinical reason for prescribing AIT was allergic rhinitis/rhino-conjunctivitis (97.7%), while more than one third of patients (35.6%) suffered from allergic asthma. On the whole, the severity of the disease, the expected patient’s compliance to treatment, the biological activity of the product and its major allergen content were highlighted as significant priorities to select a specific AIT product. Treatment cost and the possibility of avoiding the appearance of new sensitizations were considered as low-priority factors. Symptom reduction on treatment, followed by sustained efficacy after discontinuation, were the two top reasons for prescribing AIT. Cluster analysis showed six distinct prescribing profiles, with important heterogeneity between regions and clinical settings. Patients’ age, disease severity, allergen profile, physician age and experience, and importance of patient-centered versus product-centered factors were the main aspects differentiating the 6 clusters, with substantial regional variability.

Our data show that AIT prescription is highly heterogeneous and driven by complex combinations of patient’s characteristics, physician priorities, and regional context rather than uniform guideline-based criteria. These findings support the need for greater consideration of real-world decision drivers in future AIT recommendations and guidelines.