Review Compares Intranasal Steroid Preparations for Chronic Rhinosinusitis
For patients with chronic rhinosinusitis, study authors found insufficient data to suggest that one type of intranasal steroid was more effective than another.
A systematic review published in the Cochrane Library evaluated primary medical treatment options for patients with chronic rhinosinusitis, a common condition characterized by inflammation of the nasal lining and paranasal sinuses. Topical corticosteroids are prescribed to reduce inflammation in the sinonasal mucosa and provide symptomatic relief. Researchers conducted a review to evaluate the effects of different intranasal steroids in patients with chronic rhinosinusitis via The Cochrane ENT Information Specialist.
Trials included in the analysis were randomized-controlled trials with a follow-up period of at least 3 months comparing first-generation intranasal corticosteroids (eg, beclomethasone dipropionate, triamcinolone acetonide, flunisolide, budesonide) vs. second-generation intranasal corticosteroids (eg, ciclesonide, fluticasone furoate, fluticasone propionate, mometasone furoate, betamethasone sodium phosphate), or sprays vs. drops, or low- vs. hig-dose intranasal steroids.
The primary outcomes were disease-specific health-related quality of life (HRQL), patient-reported disease severity, and incidence of epistaxis.
Of the nine total studies (n=911) included, two small studies comparing fluticasone propionate vs. beclomethasone dipropionate found no difference in disease severity or incidence of epistaxis. Study authors reported the evidence to be very low quality.
One study comparing fluticasone propionate vs. mometasone furoate found no difference in disease severity, as measured by nasal symptoms scores. Study authors also reported the evidence to be very low quality.
Five studies comparing high-dose vs. low-dose steroids consisted of three using mometasone furoate (400mcg vs. 200mcg [adults and older children], 200mcg vs. 100mcg [younger children]), and two using fluticasone propionate drops (800mcg vs. 400mcg). Study authors reported similar results between high- and low-doses relating to disease severity and size of nasal polyps. A greater improvement in polyp score was seen in the high-dose groups across all studies but "the significance is unclear due to the small size of the improvements," added Lee Yee Chong, UK Cochrane Centre, Oxford, UK. The evidence was deemed low quality. Epistaxis was more commonly seen with use of higher doses (risk ratio [RR] 2.06, 95% CI: 1.20-3.54); this was deemed moderate quality evidence.
Only one study examined aqueous nasal spray vs. aerosol spray but there were significant baseline differences between the study participants in the two groups as well as an unclear number of participants for comparison. Study authors were not able to make meaningful conclusions based on the data; no studies compared drops vs. spray.
Overall, there was not enough evidence to conclude that one type of intranasal steroid was more effective over another, nor that the efficacy of a nasal spray was different from an aerosol spray. Based on moderate quality evidence, there was an increased risk of epistaxis when higher doses were used and may be a factor that impacts patient compliance. Additional research is needed "with specific attention given to trial design, disease-specific health-related quality of life outcomes and evaluation of longer-term outcomes and adverse effects," concluded Chong.
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