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Meta-Analysis
. 2017 Dec 28;7(12):e016326.
doi: 10.1136/bmjopen-2017-016326.

Applicability of evidence from previous systematic reviews on immunotherapy in current practice of childhood asthma treatment: a GRADE (Grading of Recommendations Assessment, Development and Evaluation) systematic review

Erik-Jonas van de Griendt  1   2 , Mariska K Tuut  3 , Hans de Groot  4 , Paul L P Brand  5   6
Affiliations
Meta-Analysis

Applicability of evidence from previous systematic reviews on immunotherapy in current practice of childhood asthma treatment: a GRADE (Grading of Recommendations Assessment, Development and Evaluation) systematic review

Erik-Jonas van de Griendt et al. BMJ Open. .

Abstract

Objective: Because most children with asthma now use inhaled corticosteroids (ICS), the added benefit of immunotherapy in asthmatic children needs to be examined. We re-assessed the effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) in childhood asthma treatment focusing on studies with patient-relevant outcome measures and children using ICS.

Methods: We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to systematically search and appraise the evidence using predefined critical patient-relevant outcomes (asthma symptoms, asthma control and exacerbations). We searched to retrieve systematic reviews and randomised controlled trials on immunotherapy for asthma in children (1960-2017). We assessed the quality of the body of evidence with GRADE criteria.

Results: The quality of the evidence for SCIT was very low due to a large risk of bias and indirectness (dated studies in children not using ICS). No effect of SCIT was found for asthma symptoms; no studies reported on asthma control. For asthma exacerbations, studies favoured SCIT. We have little confidence in this effect estimate, due to the very low quality of evidence. For SLIT, quality of the evidence was very low due to a large risk of bias, indirectness and imprecision. The outcome 'asthma symptoms' could not be calculated due to lack of standardisation and large clinical heterogeneity. Other predefined outcomes were not reported.

Conclusion: The beneficial effects of immunotherapy in childhood asthma found in earlier reviews are no longer considered applicable, because of indirectness (studies performed in children not being treated according to current asthma guidelines with ICS). There was absence of evidence to properly determine the effectiveness or lack thereof of immunotherapy in asthma treatment in children with ICS.

Keywords: GRADE; adolescents; allergy; asthma; children; efficacy; immunotherapy; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Literature search and selection. RCT, randomised controlled trial; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy.
Figure 2
Figure 2
Meta-analysis of SCIT versus placebo, outcome asthma symptoms. IV, inverse variance; Random, random effect model; SCIT, subcutaneous immunotherapy; Std, standardised.
Figure 3
Figure 3
Meta-analysis of SCIT vs placebo, outcome asthma exacerbations. IV, inverse variance; SCIT, subcutaneous immunotherapy.
See this image and copyright information in PMC

References

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