Evidence for the effectiveness of intranasal corticosteroids in the management of non-allergic rhinitis appears to be lacking, according to a recently published systematic review.
Due to the limited number of effective treatment options for patients with non-allergic rhinitis, the study authors aimed to assess the efficacy of intranasal corticosteroids in this patient population. Various electronic databases were searched to obtain randomized controlled trials (RCTs) that compared intranasal corticosteroids to placebo/no intervention or another therapy (ie, saline irrigation, intranasal antihistamines, capsaicin, ipratropium bromide) in patients ≥12 years old.
Patient-reported disease severity as well as a significant adverse event (epistaxis) were designated as the primary outcomes of interest. Secondary end points included health-related quality of life, airflow (measured objectively), and other adverse events. For each outcome, the certainty of evidence was assessed using GRADE.
Of the 34 studies included (n=4452) in the analysis, only 13 (n=2045) reported data comparing intranasal corticosteroids to placebo. The authors noted that the follow-up period of the studies was up to 3 months and that dosages of intranasal corticosteroids ranged from 50µg to 2000µg daily.
“Intranasal corticosteroid treatment may improve patient‐reported disease severity as measured by total nasal symptom score compared with placebo at up to 4 weeks (standardized mean difference [SMD] ‐0.74, 95% confidence interval (CI) ‐1.15 to ‐0.33; 4 studies; 131 participants; I2 = 22%) (low‐certainty evidence),” the authors reported. They added, “However, between 4 weeks and 3 months the evidence is very uncertain (SMD ‐0.24, 95% CI ‐0.67 to 0.20; 3 studies; 85 participants; I2 = 0%) (very low‐certainty evidence).” A slight improvement was also observed in the total nasal symptom score from baseline to up to 4 weeks for patients who received intranasal corticosteroids vs placebo (SMD: -0.15; 95% CI: -0.25 to -0.05; 4 studies; n=1465; I2: 35%; low certainty evidence).
Results of the analysis also revealed a higher risk of epistaxis for patients who received intranasal corticosteroids (65 per 1000) vs placebo (31 per 1000) (risk ratio [RR]: 2.10; 95% CI: 1.24 to 3.57; 4 studies; n=1174; I2 = 0%; moderate certainty evidence). The study authors also reported that because very few studies compared the safety and efficacy of intranasal corticosteroids to other therapies, it was difficult to draw conclusions on treatment differences.
“It is unclear whether intranasal corticosteroids reduce patient‐reported disease severity in non‐allergic rhinitis patients compared with placebo when measured at up to 3 months,” the authors concluded. They added, “However, intranasal corticosteroids probably have a higher risk of the adverse effect epistaxis.”
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