Dosing Reactions and Missed Doses Affect Peanut Oral Immunotherapy Outcomes.

Abstract

Peanut oral immunotherapy (pOIT) is a recognized treatment for patients with peanut allergy, though not all patients who undergo this therapy achieve desensitization or remission. To determine whether missed doses or dosing reactions predict clinical outcomes with pOIT. Data from IMPACT (Oral Immunotherapy for Induction of Tolerance in Peanut Allergic Children trial), a randomized, double-blind, placebo-controlled trial of pOIT in children aged 1 to 4 years with peanut allergy, were analyzed to determine whether treatment-emergent variables influence desensitization (ability to consume 5000 mg of peanut protein without reaction during a blinded oral food challenge after 134 weeks of pOIT) and remission (6 months after discontinuation of pOIT). Logistic regression models, controlling for age and Ara h2-specific IgE, were performed to assess the relationship between dosing reactions, missed doses, and outcomes. Consecutive missed doses during build-up significantly correlated with reduced likelihood of desensitization (P = .03; odds ratio [OR], 0.69; 95% CI, 0.49-0.96), whereas consecutive missed doses during maintenance did not (P = .10; OR, 0.79; 95% CI, 0.59-1.05). Furthermore, the total individual missed doses did not significantly correlate with desensitization or remission in either phase of pOIT. Conversely, dosing reactions during maintenance did significantly correlate with reduced likelihood of desensitization (P = .01; OR, 0.71; 95% CI, 0.54-0.93), whereas dosing reactions during build-up did not significantly correlate with desensitization (P = .57; OR, 0.95; 95% CI, 0.79-1.14). Fewer than 10% of missed doses were attributed to dosing reactions. Missed doses during therapy and dosing reactions during maintenance associated with poorer pOIT outcomes. Clinicians should support adherence during build-up and consider dose adjustments for patients having dosing reactions during maintenance therapy.