PMID- 27084419
OWN - NLM
STAT- MEDLINE
DCOM- 20171026
LR  - 20220321
IS  - 2213-2201 (Electronic)
VI  - 4
IP  - 4
DP  - 2016 Jul-Aug
TI  - Minimal Clinically Important Difference (MCID) in Allergic Rhinitis: Agency for 
      Healthcare Research and Quality or Anchor-Based Thresholds?
PG  - 682-688.e6
LID - S2213-2198(16)00056-8 [pii]
LID - 10.1016/j.jaip.2016.02.006 [doi]
AB  - BACKGROUND: In 2013, the Agency for Healthcare Research and Quality (AHRQ) 
      recommended that allergic rhinitis (AR) studies calculate a minimal clinically 
      important difference (MCID) based on an estimated threshold equal to 30% of the 
      maximum total nasal symptom score. Applying this threshold, their data showed no 
      differences between well-established treatments, and a subsequent analysis using 
      prescribing information found no differences between active treatments and 
      placebo controls. OBJECTIVE: The objective of this study was to demonstrate the 
      application of an evidence-based model to determine MCIDs for AR studies, with an 
      absolute value for an anchor-based threshold and validated methods for 
      calculating distribution-based thresholds. METHODS: Using the same studies as the 
      AHRQ report, anchor- and distribution-based MCID thresholds were determined for 3 
      clinical comparisons identified by the AHRQ: (1) oral antihistamine+intranasal 
      corticosteroid (INCS) versus INCS, (2) montelukast versus INCS, and (3) 
      intranasal antihistamine+INCS in a single device versus the monotherapies. The 
      outcomes were compared with those reported using the AHRQ threshold. RESULTS: No 
      treatment comparison met the AHRQ-defined MCID threshold; all treatments were 
      determined to be equivalent for all 3 queries. In contrast, the evidence-based 
      model revealed some differences between treatments: INCS > montelukast; 
      intranasal antihistamine+INCS > either monotherapy. No clinically relevant 
      benefit was observed for adding an oral antihistamine to INCS, but some studies 
      were not optimal choices for quantitative determination of MCIDs. Updating the 
      literature search revealed no additional studies that met the AHRQ inclusion 
      criteria. CONCLUSIONS: The evidence-based threshold for MCID determination for AR 
      studies should supersede the threshold recommended in the AHRQ report.
CI  - Copyright (c) 2016 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Meltzer, Eli O
AU  - Meltzer EO
AD  - Division of Immunology and Allergy, Department of Pediatrics, University of 
      California San Diego School of Medicine, San Diego, Calif; Allergy and Asthma 
      Medical Group and Research Center, San Diego, Calif. Electronic address: 
      eliomeltzer@gmail.com.
FAU - Wallace, Dana
AU  - Wallace D
AD  - Florida Center for Allergy and Asthma Control, Nova Southeastern University 
      College of Health Professions, Fort Lauderdale, Fla.
FAU - Dykewicz, Mark
AU  - Dykewicz M
AD  - Section of Allergy and Immunology, Department of Internal Medicine, Saint Louis 
      University School of Medicine, St. Louis, Mo.
FAU - Shneyer, Lucy
AU  - Shneyer L
AD  - Shneyer Statistics LLC, Denville, NJ.
LA  - eng
PT  - Journal Article
DEP - 20160412
PL  - United States
TA  - J Allergy Clin Immunol Pract
JT  - The journal of allergy and clinical immunology. In practice
JID - 101597220
RN  - 0 (Acetates)
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Cyclopropanes)
RN  - 0 (Histamine Antagonists)
RN  - 0 (Quinolines)
RN  - 0 (Sulfides)
RN  - MHM278SD3E (montelukast)
SB  - IM
CIN - J Allergy Clin Immunol Pract. 2016 Jul-Aug;4(4):689-90. PMID: 27393780
MH  - Acetates/therapeutic use
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Cyclopropanes
MH  - Evidence-Based Medicine
MH  - Government Agencies
MH  - Histamine Antagonists/therapeutic use
MH  - Humans
MH  - *Minimal Clinically Important Difference
MH  - Quinolines/therapeutic use
MH  - Rhinitis, Allergic/*drug therapy
MH  - Sulfides
MH  - United States
OTO - NOTNLM
OT  - Allergic rhinitis
OT  - Intranasal antihistamine
OT  - Intranasal corticosteroid
OT  - Leukotriene receptor antagonist
OT  - Minimal clinically important difference (MCID)
OT  - Oral antihistamine
OT  - Seasonal allergic rhinitis (SAR)
OT  - Total nasal symptom score (TNSS)
EDAT- 2016/04/17 06:00
MHDA- 2017/10/27 06:00
CRDT- 2016/04/17 06:00
PHST- 2015/10/19 00:00 [received]
PHST- 2016/01/19 00:00 [revised]
PHST- 2016/02/17 00:00 [accepted]
PHST- 2016/04/17 06:00 [entrez]
PHST- 2016/04/17 06:00 [pubmed]
PHST- 2017/10/27 06:00 [medline]
AID - S2213-2198(16)00056-8 [pii]
AID - 10.1016/j.jaip.2016.02.006 [doi]
PST - ppublish
SO  - J Allergy Clin Immunol Pract. 2016 Jul-Aug;4(4):682-688.e6. doi: 
      10.1016/j.jaip.2016.02.006. Epub 2016 Apr 12.