Two‐year post‐treatment outcomes following peanut oral immunotherapy in the Probiotic and Peanut Oral Immunotherapy‐003 Long‐Term (PPOIT‐003LT) study

Abstract

AbstractBackgroundFew studies have examined long‐term outcomes following oral immunotherapy (OIT); none have examined long‐term risks and benefits associated with distinct clinical outcomes (desensitization, remission).MethodsParticipants completing the probiotic and peanut oral immunotherapy (PPOIT) ‐003 randomized trial were enrolled in a follow‐on study, PPOIT‐003LT. Peanut ingestion, reactions, and health‐related quality of life (HRQOL) were monitored prospectively. Outcomes at 1‐year and 2‐years post‐treatment were examined by treatment group and by post‐OIT clinical outcome (remission, desensitization without remission [DWR], allergic).Results86% (151/176) of eligible children enrolled. Post‐treatment peanut ingestion at 2‐years post‐treatment were similar for PPOIT (86.7%) and OIT (78.7%) groups, both higher than placebo (10.3%). Reactions reduced over time for all treatment and clinical outcome groups (PPOIT 31.7% to 23.3%, OIT 37.7% to 19.7%, placebo 13.8% to 6.9%; remission 27.5% to 15.9%; DWR 57.9% to 36.8%; allergic 11.6% to 7%). At 2‐years post‐treatment, similar proportions of remission and allergic participants reported reactions (RD 0.09 (95%CI −0.03, 0.20), p = .127), whereas more DWR participants reported reactions than remission (remission vs DWR: RD −0.21 (95%CI −0.39; −0.03), p = .02) and allergic (DWR vs allergic: RD 0.30 (95%CI 0.13, 0.47), p = .001) participants. At 2‐years post‐treatment, 0% remission versus 5.3% DWR versus 2.3% allergic participants reported adrenaline injector usage. Remission participants had significantly greater HRQOL improvement (adjusted for baseline) compared with both DWR (MD −0.54 (95%CI −0.99, −0.10), p = .017) and allergic (MD −0.82 (95%CI −1.25, −0.38), p < .001).ConclusionBy 2‐years post‐treatment, remission participants reported fewer reactions, less severe reactions and greater HRQOL improvement compared with DWR and allergic participants, indicating that remission is the patient‐preferred treatment outcome over desensitization or remaining allergic.