D2.227 - US Regional Difference in Allergen Immunotherapy Prescription Patterns: Focus on Puerto Rico

Little is known about the drivers for the prescription of allergen immunotherapy (AIT). The CHOICE-Global study seeks to determine whether variations exist internationally for these drivers (e.g., allergic disease to warrant AIT, aeroallergen type, co-existing pharmacotherapy, etc.). In this subgroup analysis, we investigated differences in drivers of AIT for patients in Puerto Rico (PR) relative to other US regions.

The CHOICE-Global study is a prospective, multi-center, observational, non-interventional real-life survey performed in 8 regions in the world. US data were gathered for 10 months using prescribing clinician-directed, and patient-directed questionnaires, both collected anonymously in an online platform. Names of AIT products were not recorded. Patients were categorized by US region and presented in numbers and percentages. Characteristics for patients from PR relative to other US regions were compared using Chi square testing.

Data were collected on n=491 unique US patients prescribed AIT, corresponding to 302 (South), 61 (Midwest), 53 (Northeast; NE), 39 (West) and 36 (PR). Children younger than 12 years were most commonly prescribed AIT in PR (16.7% of all patients) and least commonly in the Midwest and the NE (0%) (p<0.0001). Sensitization to dust mites was highest in PR (91.7%) and lowest in the West (41.0%) (p<0.0001), while sensitization to molds was lowest in PR (11.1%) and highest in the NE (62.3%) (p=0.0001). Patients from PR were most commonly on 2+ current treatments for allergic symptoms at the time of AIT initiation (91.7%), and least commonly in patients from the West (74.4%) (p=0.0364). Nasal corticosteroids were always included as current treatments in patients from PR (100%), but were only used in 49.1% of patients from the NE (p<0.0001). The number of aeroallergens used in AIT was 2+ in 98.1% of patients from the NE but only in 61.6% of patients from PR (p<0.0001). The main reason for prescribing AIT was reduction of symptoms in 88.8% of patients from PR vs. only 30.2% of patients from the NE (p<0.0001). Conjunctivitis was most commonly the main disease indication for prescribing AIT in patients from PR (47.2%) and least commonly in patients from the NE (9.4%) (p<0.0001).

The patient characteristic and sensitization profiles, and reasons for AIT prescription vary substantially between PR and other US regions perhaps due to differences in training, and may lead to treatment disparities.