According to the results of a recently published systematic review, the combination of intranasal azelastine plus fluticasone is more effective in reducing symptom scores in patients with allergic rhinitis (AR) than either component alone.

To evaluate the effectiveness of azelastine-fluticasone nasal spray (AzeFlu), study authors systematically searched the PubMed, EMBASE, Cochrane, and MEDLINE databases for randomized controlled trials comparing patient-reported symptom scores in adults and children receiving combination therapy vs azelastine, fluticasone, or placebo. Patient-reported symptom scores included Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score (TOSS), and Rhinitis Quality of Life Questionnaire (RQLQ).  

“Meta-analysis was performed on studies reporting differences in TNSS change from baseline with standard deviations or confidence intervals for more than 1 treatment group,” the authors stated.

A total of 8 studies were included in the systematic review. The study authors reported that, in all studies analyzed, there was a greater reduction in patient-reported symptom scores in those receiving combination therapy compared with those receiving monotherapy or placebo.

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Additionally, study results showed that AzeFlu combination therapy was superior in reducing TNSS vs placebo (mean change from baseline: -2.41; 95% CI: -2.82, -1.99; P<.001, I2 = 60%), azelastine (mean change from baseline: −1.40; 95% CI: −1.82, −0.98; P<.001; I2 = 0%), as well as fluticasone (mean change from baseline: −0.74; 95% CI: −1.17, −0.31; P<.001; I2 = 12%). The study authors noted that the risk of bias for all studies was considered “generally low.”

Results of this analysis demonstrated that AzeFlu is both superior and more efficacious in reducing patient-reported symptom scores compared to either azelastine or fluticasone monotherapy in patients with AR. The study authors concluded, “ Combination nasal spray should be considered as second-line therapy in patients with allergic rhinitis that is not controlled with monotherapy.”

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