Real-World Use, Prescribing Patterns, and Short-Term Clinical Evolution of Extensively Hydrolyzed and Hydrolyzed Rice...

Area of Science:

• Pediatric Nutrition
• Allergy and Immunology
• Gastroenterology

Background:

• Hydrolyzed rice formulas (HRFs) are emerging as an alternative for infants with cow's milk protein allergy (CMPA).
• Limited real-world data exist on HRF prescribing patterns and early clinical outcomes in CMPA management.
• Understanding HRF use is crucial for optimizing nutritional strategies in allergic infants.

Purpose of the Study:

• To describe real-world prescribing patterns of HRF versus extensively hydrolyzed formulas (eHF) in infants with CMPA.
• To identify factors influencing the recommendation of HRF for CMPA.
• To assess the short-term clinical evolution of CMPA symptoms following the introduction of HRF or eHF.

Main Methods:

• Observational analysis from the ETAPA project, including prospective (recommendation) and retrospective (treatment) infant cohorts.
• Analysis of 1505 infant records, assessing variables associated with HRF vs. eHF recommendation.
• Evaluation of 7-day clinical evolution using the Cow's Milk-allergic Symptom Scale (CoMiSS), with propensity score weighting for confounding.

Main Results:

• HRF was recommended in 19.6% of cases in the prospective cohort; older age favored HRF, while IgE-mediated CMPA favored eHF.
• In the retrospective cohort, both HRF and eHF led to significant CoMiSS score reductions within 7 days.
• Adjusted analysis showed no statistically significant difference in CoMiSS reduction between HRF and eHF (p=0.091).

Conclusions:

• HRF is utilized across diverse CMPA profiles in routine pediatric practice, demonstrating clinically relevant short-term symptom improvement.
• Findings support HRF as an additional nutritional option for managing CMPA.
• The observational design does not permit conclusions of equivalence or non-inferiority compared to eHF.