Factors Influencing Aspirin Therapy after Desensitization (ATAD) Tolerance in Aspirin-Exacerbated Respiratory Disease (AERD) Patients.

Abstract

Background: For over 40 years, aspirin desensitization (AD) with aspirin therapy after desensitization (ATAD) has been a recognized treatment for Aspirin-Exacerbated Respiratory Disease (AERD). This study aimed to characterize the rate of ATAD-associated complications leading to discontinuation and identify associated risk factors.

Objective: To evaluate the rate and causes of ATAD intolerance and identify demographic factors that may predict intolerance in AERD patients.

Methods: 360 AERD patients who underwent AD and ATAD at a tertiary center from August 2016 to April 2024 were reviewed. A joint model combining linear mixed and Cox proportional hazards models was used to assess associations between demographic factors, aspirin dosage, and ATAD intolerance.

Results: Of 278 patients included, four (1.4%) failed desensitization, and 44 (15.8%) discontinued ATAD. 10 patients (3.6%) experienced major complications requiring ED visit or hospitalization. Common discontinuation causes included gastrointestinal symptoms, anaphylaxis, cutaneous reactions, and airway symptom exacerbation. On average, aspirin dosage decreased overtime (-10 mg daily per month; p < 0.0001) and was lower in older patients (-7.78 mg daily; p < 0.0001), reflecting current dosage practices. Peri-/post-menopausal female status was associated with reduced ATAD intolerance risk (HR = 0.4; p = 0.041), while pre-menopausal status showed a non-significant increase (HR = 2.28; p = 0.087). ATAD intolerance was more likely in Hispanic/Latino (HR = 8.2; p = 0.0013) and African American patients (HR = 4.03; p = 0.0015), and increased modestly with age (HR = 1.08; p < 0.0001). Longitudinal aspirin dosage was not associated with overall intolerance or intolerance due to gastrointestinal complications specifically after adjustment.

Conclusion: ATAD tolerance was lower in Hispanic/Latino, African American, and older patients, higher in peri-/post-menopausal females, and not associated with longitudinal aspirin dosage.