Do intranasal corticosteroids have a role in non‐allergic rhinitis?
Netherlands: Intranasal corticosteroids are one of the most common types of medication prescribed in patients with non-allergic rhinitis. However, according to a recently published Cochrane review, it is unclear whether intranasal corticosteroids compared to placebo reduces disease severity in patients with non‐allergic rhinitis when measured up to 3 months. Also, there are very few studies comparing intranasal corticosteroids to other treatment modalities making it difficult to draw conclusions.
Nonallergic rhinitis (vasomotor rhinitis) is a condition presented with symptoms of chronic sneezing, congestion, or runny nose similar to those present in allergic rhinitis. However, unlike an allergy, nonallergic rhinitis doesn’t involve the immune system.
People with non-allergic rhinitis often lack an effective treatment due to poor understanding of the underlying disease mechanism. Intranasal corticosteroids are one of the most common types of medication prescribed in patients with rhinitis or rhinosinusitis symptoms, including those with non‐allergic rhinitis. However, it is unclear whether intranasal corticosteroids are truly effective in these patients.
Wytske Fokkens, Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, Netherlands, and colleagues assessed the effects of intranasal corticosteroids in the management of non‐allergic rhinitis.
The researchers searched the online databases and included randomized controlled trials (RCTs) comparing intranasal corticosteroids, delivered by any means and in any volume, with (a) placebo/no intervention or (b) other active treatments in adults and children (aged ≥ 12 years).
Out of the 34 included studies with 4452 participants, only 13 studies provided data for the main comparison, intranasal corticosteroids versus placebo. The participants were mainly defined as patients with perennial rhinitis symptoms and negative allergy tests.
No distinction between different pheno‐ and endotypes could be made, although a few studies only included a specific phenotype such as pregnancy rhinitis, vasomotor rhinitis, rhinitis medicamentosa or senile rhinitis. Most studies were conducted in a secondary or tertiary healthcare setting. No studies reported outcomes beyond three months follow‐up. Intranasal corticosteroid dosage in the review ranged from 50 µg to 2000 µg daily.
Key findings of the study include:
- Intranasal corticosteroid treatment may improve patient‐reported disease severity as measured by total nasal symptom score compared with placebo at up to four weeks (SMD ‐0.74; 4 studies; 131 participants; I2 = 22%) (low‐certainty evidence). However, between four weeks and three months the evidence is very uncertain (SMD ‐0.24; 3 studies; 85 participants; I2 = 0%) (very low‐certainty evidence).
- Intranasal corticosteroid treatment may slightly improve patient‐reported disease severity as measured by total nasal symptom score change from baseline when compared with placebo at up to four weeks (SMD ‐0.15; 4 studies; 1465 participants; I2 = 35%) (low‐certainty evidence).
- All four studies evaluating the risk of epistaxis showed that there is probably a higher risk in the intranasal corticosteroids group (65 per 1000) compared to placebo (31 per 1000) (risk ratio (RR) 2.10; 4 studies; 1174 participants; I2 = 0%) (moderate‐certainty evidence).
- The absolute risk difference (RD) was 0.04 with a number needed to treat for an additional harmful outcome (NNTH) of 25.
- Only one study reported numerical data for quality of life. It did report a higher quality of life score in the intranasal corticosteroids group (152.3 versus 145.6); however, this disappeared at longer‐term follow‐up (148.4 versus 145.6) (low‐certainty evidence).
- Only two studies provided data for the outcome objective measurements of airflow. Neither found a significant difference between the intranasal corticosteroids and placebo group (rhinomanometry SMD ‐0.46; 44 participants; peak expiratory flow rate SMD 0.78; 11 participants) (very low‐certainty evidence).
- Intranasal corticosteroids probably resulted in little or no difference in the risk of other adverse events compared to placebo (RR 0.99; 3 studies; 1130 participants; I2 = 0%) (moderate‐certainty evidence).
"The certainty of the evidence for most outcomes in this review was low or very low. It is not clear whether intranasal corticosteroids reduce patient‐reported disease severity in non‐allergic rhinitis patients compared with placebo when measured at up to three months. However, intranasal corticosteroids probably have a higher risk of the adverse effect epistaxis. There are very few studies comparing intranasal corticosteroids to other treatment modalities making it difficult to draw conclusions," concluded the authors.
For further reference follow the link: https://doi.org/10.1002/14651858.CD010592.pub2