As-needed intranasal corticosteroid spray for allergic rhinitis: a systematic review and meta-analysis (original) (raw)
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International Forum of Allergy & Rhinology
Background: When a standard dose of intranasal corticosteroid (INCS) fails to control symptoms of allergic rhinitis (AR), a double dose of INCS is optional. This systematic review aimed to assess the effects of double-dose INCS. Methods: Literature searches were performed using MED-LINE and EMBASE. Randomized controlled trials that studied the effects of double-dose INCS vs standard-dose INCS for treating patients with AR were included. Data from the included studies were extracted and collected for metaanalyses. The outcomes were nasal symptoms, ocular symptoms, and adverse events. Results: Twelve studies (4166 patients) met the inclusion criteria. There were 5 pediatric studies (1868 patients), 5 adult studies (1414 patients), and 2 studies with mixed populations (884 patients). The meta-analysis results in adult patients favored the effects of double-dose INCS on: total nasal symptom score (standardized mean difference [SMD] −0.25; 95% confidence interval [CI], −0.41 to −0.08; 4 studies; 568 patients) and total ocular symptom score (SMD −0.27; 95% CI, −0.52 to −0.03; 1 study; 259 patients). The meta-analysis results in pediatric patients did not show the difference between groups on total nasal symptom score (SMD −0.16; 95% CI, −0.40 to 0.07; 3 studies; 801 patients). The meta-analysis of ocular symptom score in pediatric patients had insufficient data. There were no differences between groups on adverse events. Conclusion: Double-dose INCS showed be er improvement in nasal and ocular symptoms in adult patients with AR when compared to the standard dose. These beneficial effects were not seen in the pediatric population. Adverse events between groups were not different. C 2018 ARS-AAOA, LLC.
International Forum of Allergy & Rhinology, 2018
Background: A combination of H1 antihistamine (AH) with intranasal corticosteroid (INCS) is commonly prescribed to patients with allergic rhinitis (AR) who have an inadequate response to monotherapy. In this systematic review we aimed to determine the effects of AH combined with INCS (AH-INCS) for treating AR. Methods: Literature searches were performed using Medline and Embase. Randomized, controlled trials that studied the effects of AH-INCS vs INCS monotherapy for treating patients with AR were included. The primary outcomes were total nasal symptom scores, total ocular symptom scores, and disease-specific quality of life. The secondary outcomes were objective tests for nasal patency and adverse events. Results: Sixteen studies (4026 patients) met the inclusion criteria. Compared with INCS, AH-INCS decreased total nasal symptom scores (standardized mean difference [SMD], −0.13; 95% confidence interval [CI], −0.19 to −0.06; p < 0.001; 10 trials, 3348 patients) and total ocular symptom scores (SMD, −0.12, 95% CI, −0.20 to −0.04; p = 0.003; 6 trials, 2378 patients). Subgroup analysis indicated no benefit with the oral AH-INCS combination but did show benefit with intranasal AH-INCS (SMD, −0.18; 95% CI, −0.27 to −0.09; p < 0.001). There were no significant differences with regard to disease-specific quality of life (SMD, −0.07; 95% CI, −0.16 to 0.02; p = 0.12; 6 trials, 1981 patients), nasal inspiratory flow (MD, −0.03 L/min; 95% CI, −0.57 to 0.50; p = 0.91; 1 trial, 54 patients), or adverse events. Conclusion: Intranasal AH-INCS has benefit over INCS on nasal and ocular symptom improvement for treating AR. Oral AH-INCS is not recommended. C 2018 ARS-AAOA, LLC.
International Forum of Allergy & Rhinology, 2018
Background: Intranasal corticosteroid (INCS) is the most efficacious medicine for treating chronic rhinitis. A decongestant and INCS combination (INCS-D) is considered for nasal congestion that is not improved by INCS. This study aimed to investigate the effects of INCS-D on chronic rhinitis. Methods: Literature searches were performed using MED-LINE and EMBASE. Randomized controlled trials studying the effects of INCS-D vs INCS alone for treating chronic rhinitis were included. Data were pooled for meta-analysis. Outcomes were nasal symptoms, disease-specific quality of life, objective tests for nasal patency, and adverse events. Results: Six studies (1071 patients) met the inclusion criteria. There were no differences between INCS-D and INCS on total nasal symptom scores (standardized mean difference [SMD] −0.85; 95% confidence interval [CI], −2.09 to 0.40; p = 0.18), nasal congestion scores (SMD −0.13; 95% CI, −0.46 to 0.20; p = 0.43), and the Rhinoconjunctivitis Quality of Life Questionnaire score (SMD −0.12; 95% CI, −0.66 to 0.42; p = 0.66). A er 1 week, there were no differences on objective tests for nasal patency (acoustic rhinometry: SMD 0.04; 95% CI, −0.68 to 0.76, p = 0.91; and peak nasal inspiratory flow: SMD 0.08; 95% CI, −0.16 to 0.32; p = 0.52). Adverse events were not different between INCS-D and INCS (risk ratio 1.09; 95% CI, 0.73 to 1.62). Conclusion: Meta-analyses did not show benefits of topical decongestants addition to INCS. Adverse events of INCS-D were comparable with INCS.
Therapeutic Index (TIX) for intranasal corticosteroids in the treatment of allergic rhinitis
Rhinology, 2011
Intranasal corticosteroids (INS) are the first line treatment for allergic rhinitis (AR). To guide clinical decision-making, we created a therapeutic index (TIX) for INS reflecting efficacy and safety. A Medline search (1966 to June 2009) was carried out to identify all placebo-controlled randomized trials, and observational reports for safety issues, with Dexamethasone, Budesonide (BUD), Fluticasone propionate (FP), Fluticasone furoate (FF), Flunisolide, Mometasone furoate (MF), Triamcinolone (TRIAM), and Beclomethasone dipropionate (BDP) as treatment for AR. Data on three efficacy (nasal symptoms, ocular symptoms, global assessment) and three safety outcomes (epistaxis, growth, systemic ocular effects) were extracted. Meta analyses were performed for each INS and outcome and results were categorised into scores by quartiles. Scores of the three efficacy and safety outcomes were summed up to create summation scores for efficacy (ES) and side effects (AES), respectively with a maxim...
Impact of intranasal corticosteroids on asthma outcomes in allergic rhinitis: a meta-analysis
Allergy, 2013
Given the relationship between allergic rhinitis (AR) and asthma, it can be hypothesized that reducing inflammation in the upper airway with intranasal corticosteroid (INCS) medications may improve asthma outcomes. The goal of this study was to perform a systematic review with meta-analysis of the efficacy of INCS medications on asthma outcomes in patients with AR and asthma. Asthma-specific outcomes from randomized, controlled studies evaluating INCS medications in patients with AR were evaluated, including studies that compared INCS sprays to placebo, INCS sprays plus orally inhaled corticosteroids to orally inhaled corticosteroids alone, and nasally inhaled corticosteroids to placebo. Sufficient data for meta-analysis were retrieved for 18 trials with a total of 2162 patients. Asthma outcomes included pulmonary function, bronchial reactivity, asthma symptom scores, asthma-specific quality of life, and rescue medication use. The subgroup of studies comparing INCS spray to placebo had significant improvements in FEV1 (SMD = 0.31; 95% CI, 0.04-0.58), bronchial challenge (SMD = 0.46; 95% CI, 0.12-0.79), asthma symptom scores (SMD = À0.42; 95% CI, À0.53 to À0.30), and rescue medication use (SMD = À0.29; 95% CI, À0.58 to À0.01). Nasal inhalation of corticosteroids significantly improved morning and evening peak expiratory flow. There were no significant changes in asthma outcomes with the addition of INCS spray to orally inhaled corticosteroids. Thus, the results of this meta-analysis demonstrated that intranasal corticosteroid medications significantly improve some asthma-specific outcome measures in patients suffering from both AR and asthma. This effect was most pronounced with INCS sprays when patients were not on orally inhaled corticosteroids, or when corticosteroid medications were inhaled through the nose into the lungs. Overall, intranasal corticosteroid medications improve some asthma-specific outcome measures in patients with both AR and asthma. Further research is needed to clarify the role of INCS sprays as asthma-specific therapy, as well as the role of the nasal inhalation technique as a monotherapy in patients suffering from both asthma and AR.
Patient Related Outcome Measures, 2011
Background: Allergic rhinitis affects 10%-20% of the US population. Its chronic nature, combined with patients' perceptions of safety/efficacy, administration, and sensory attributes of nasal sprays (corticosteroids), impact patient adherence to therapy. The purpose of this study was to develop a measure of experience with and preference for corticosteroid therapy for treatment of allergic rhinitis. Methods: Questionnaire development was conducted through qualitative research including concept elicitation and content testing in 153 patients with allergic rhinitis. Patient focus groups (n = 66), in conjunction with content confirmation and saturation in additional groups (n = 87), provided research data. A literature-based conceptual framework was incorporated into the interview guide. An iterative process of data collection, analysis, and theory development yielded the conceptual framework. Results: Consistent comments from the focus groups combined with those from cognitive debriefing interviews led to the incorporation of 14 finalized attributes into the Experience with Allergic Rhinitis Nasal Spray Questionnaire (EARNS-Q) items. Between the first and second cognitive debriefing interviews, researchers revised the EARNS-Q for retesting. Face and content validity tests indicated that the items, responses, and instructions were understood by study participants. The EARNS-Q is comprised of two modules that measure patient experience with nasal sprays (experience module), and patient preference for a nasal spray relative to another (preference module). Conclusion: The EARNS-Q accurately measured patient experience with and preference for nasal sprays used in treating allergic rhinitis. A potential application of this questionnaire may be as a patient-reported outcomes endpoint in clinical trials of intranasal corticosteroids in patients with allergic rhinitis.
Journal of Evidence Based Medicine and Healthcare, 2020
BACKGROUND Allergic rhinitis is a fairly common condition. A large number of patients of allergic rhinitis are usually found in daily ENT practice. Symptoms of allergic rhinitis are still a major problem, which can affect day to day activities of an individual. Intranasal corticosteroid has potent anti-inflammatory actions and is believed to exert its beneficial effects by inhibiting several types of cells and chemicals involved in immune and inflammatory responses. Present study determines the efficacy of intra nasal corticosteroid over placebo in patients of allergic rhinitis. METHODS A single blinded non-randomised trial was conducted among patients attending allergy clinic of ENT out-patient department of a Tertiary Medical College & Hospital of West Bengal, India from March 2008 to May 2008. Two groups of patients were selected from the total sample size of 100 patients by alternate sampling technique. One group (Gr-F) was treated by intranasal corticosteroid (fluticasone nasal...
Clinical Drug Investigation, 2009
Background and objective: Intranasal corticosteroids are considered to be highly effective in patients with perennial or seasonal allergic rhinitis. Multiple intranasal corticosteroid products are available; however, an intranasal corticosteroid that treats nasal and ocular seasonal allergic rhinitis symptoms may be more cost effective by reducing the need for concomitant drugs. The purpose of this study was to compare the utilization and costs of concomitant allergic rhinitis drugs among commonly used branded intranasal corticosteroid drugs. Methods: Pharmacy claims data between 1 April 2006 and 31 January 2008 were obtained from the Wolters Kluwer SourceLx dataset. Patients with at least one pharmacy claim for a branded intranasal corticosteroid agent (fluticasone furoate, budesonide, mometasone or triamcinolone) during the index period of 1 April 2007 through 31 July 2007 were included. Study outcomes assessed were time to concomitant use of prescription allergic rhinitis drugs (other than intranasal corticosteroids) and costs of those medications and intranasal corticosteroid drugs during a 60-day post-index period. Results: A total of 793 349 patients were included in the study. At index, a majority of the patients were using mometasone (62.9%), followed by triamcinolone (21.1%), budesonide (15.1%) and fluticasone furoate (1.0%). After controlling for other covariates, patients receiving fluticasone furoate had on average a 21% lower risk of concomitant prescription allergic rhinitis drug use (adjusted hazard ratio [HR] 0.79; 95% CI 0.75, 0.83) compared with the other three branded intranasal corticosteroid agents. Compared with fluticasone furoate, all other branded intranasal corticosteroid agents incurred statistically significant higher costs of concomitant allergic rhinitis drugs (6.3%, p = 0.002), resulting in increased costs to health plans of ORIGINAL RESEARCH ARTICLE
Safety Concerns of Nasal Corticosteroids Usage in Patients With Allergic Rhinitis
Cureus, 2020
Background Intranasal corticosteroids (INCSs) are the first-line treatment for patients with moderate to severe conditions of allergic rhinitis (AR) as per current guidelines. However, patients' knowledge and practice towards the safety of such medications remains ambiguous. Therefore, this study was undertaken to identify the awareness of and knowledge about the safety of nasal corticosteroid usage in patients with allergic rhinitis as well as their adherence to taking the medication. Materials and methods We conducted a cross-sectional study from June to September 2020 at Imam Mohammad Ibn Saud Islamic University Medical Center, Riyadh, Kingdom of Saudi Arabia. Data were collected through questionnaire-based surveys, and a total of 375 patients were enrolled in the study. The eligibility criteria included all adult patients diagnosed with allergic rhinitis. Results Most of the patients had used intranasal corticosteroids. However, only two-fifths of patients stated these medic...