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Submitted: 23 June 2012 Modified: 24 February 2017
HERDIN Record #: PCHRD12062322113655

Intranasal corticosteroids for the medical management of nasal polyps in adults: A meta-analysis.

1Natividad A. Almazan-Aguilar,
2Natividad A. Almazaon-Aguilar
Department of Otolaryngology Head and Neck Surgery - Manila Central University,
Department of Otolaryngology Head and Neck Surgery - St. Luke's Medical Center

Abstract

BACKGROUND: This systematic review aims to strengthen evidence of beneficial effects of intranasal corticosteroids on the medical treatment of adults diagnosed with nasal polyps.


OBJECTIVE: (1) To determine efficacy of short-term (2-4 weeks) and long-term (4-12 weeks and > 12 weeks) use of intranasal corticosteroids for reduction of polyp size and rhinitis symptoms. (2) To determine difference in efficacy of a 400 and 800 µg dose. (3) To determine adverse effects of intranasal steroids.


STUDY DESIGN AND SELECTION CRITERIA: Meta-analysis of randomized controlled trials on intranasal steroids for nasal polyps. Patient-oriented outcomes were reduction of polyp size and overall reduction of rhinitis symptoms. Search strategy: Comprehensive search of Cochrane's Controlled Trials Registry (CCTR) Issue 2, 2003, Medline 1966 - 2002, Embase 1974 - 2002, bibliographic review, requests for information from authors and pharmaceutical companies.


DATA COLLECTION AND ANALYSIS: Sixteen studies were evaluated for inclusion, and trial quality, validity assessment, and completion of data extraction were done. Ordinal data on rhinitis and polyp scores for each study were pooled to generate relative risks. Homogeneity was assessed using approximate chi-square tests. Preset p value of < 0.10 was deemed significant for heterogeneity. Data was analyzed using Revman 4.1 (Update Software, Oxford). Sensitivity analysis was done for outcomes with significant heterogeneity.


RESULTS AND CONCLUSION: Fourteen studies found significant benefit for the use of intranasal steroids in reduction of polyp size with 2 -4 weeks treatment (RR=3.00; 95% CI: 2.39, 3.77). Overall rhinitis symptoms decreased significantly (RR=1.64; 95% CI: 1.25, 2.14) with 4-12 weeks treatment, with a tendency for reduction of rhinitis symptoms (RR=1.41; 95% CI:1.05, 1.91) with more than 12 weeks treatment. Throat irritation was significantly increased (RR=2.06; 95% CI 1.31, 3.25). There was no difference in overall rhinitis symptoms (RR=0.91; 95% CI: 0.77, 1.07) with 400 µg and 800 µg doses.

1.
Publication Type:
Journal
Publication Sub Type:
Announcements
Title:
Philippine Scientific Journal
Frequency:
Semi-Annual
Publication Date:
July-December 2005
Volume:
38
Issue:
2
Page(s):
12-25
Publisher:
Manila Central University-Filemon D. Tanchoco Medical Foundation

2.
Publication Type:
Journal
Publication Sub Type:
Journal Article, Original
Title:
Philippine Journal of Otolaryngology Head and Neck Surgery
Frequency:
Semi-Annual
Publication Date:
January-December 2007
Volume:
22
Issue:
1 & 2
Page(s):
5-11
Publisher:
Philippine Society of Otolaryngology Head and Neck Surgery

3.
Publication Type:
Research Report
Date:
November 4, 2004

LocationCall NumberAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 119/LA Fulltext pdf (Request Document)
Philippine Society of Otolaryngology-Head and Neck Surgery Abstract Print Format
1. Lildholdt , T , Rundcrantz , H , Lindqvist, N . "Efficacy of topical corticosteroid powder for nasal polyps: a double-blind, placebo-controlled study of budesonide" Clin Otolaryngol Allied Sci 20(1): 26-30, February 1995
2. Chalmers, T C, Celano, P , Sacks, H S, smith, H . "Bias in treatment assignment in controlled clinical trials" N Engl J Med 309, 1358 - 136, December 1983
3. Settipane, G A, Lund, V J, Bernstein, J , Tos , M . "Nasal Polyps, Epidemiology, Pathogenesis and Treatment" Oceanside Publications Inc., Providence, Rhode Island 29(3): 425, March 1999
4. Wigand , M , Hosemann, W . "Microsurgical treatment of recurrent nasal polyposis" Rhinol Suppl (8): 25 - 30,
5. philippine cardiovascular ,
6. Johnasen , L V, Illum, P , Kristensen, L , Petersen, S V, Synnerstad, B . "The effect of budesonide (Rhinocort) in the treatment of small and medium-sized nasal polyps" Clin Otolaryngol Allied Sci. 6(18): 524 - 527, December 1993
7. Cooper, H , Hedges, L . "The Handbook of Research Synthesis " new york : russell sage foundation , 384 - 398, 1994
8. Emerson , J d, burdick, E , hoaglin, d c, mosteller, f , Chalmers, T C. "An empirical study of the possible relation of treatment differences to quality scores in controlled randomized clinical trials" Control Clin Trials. 11(5): 339 - 352, October 1990
9. mackay, i s. ,
10. Pentilla, M , Poulsen, P , Hollingworth, K , Holmstrom, M . "Dose-related efficacy and tolerability of fluticasone propionate nasal drops 400 microg once daily and twice daily in the treatment of bilateral nasal polyposis: a placebo-controlled randomized study in adult patients" Clin Exp Allergy 30(1): 94 - 102, January 2000
11. Dingsor, G , Kramer, J , Olsholt, R , Soderstrom, T . "Flunisolide nasal spray 0.025% in the prophylactic treatment of nasal polyposis after polypectomy. A randomized, double blind, parallel, placebo controlled study" Rhinology 23(1): 49 - 58, March 1985
12. Holmberg, K , Juliusson, S , Bladder, B , Smith , D L. "Fluticasone propionate aqueous nasal spray in the treatment of nasal polyposis" Ann Allergy Asthma Immuno 78(3): 270 - 276, March 1997
13. Lund, V , Flood, J , Sykes, A , Ricards, D . "Effect of fluticasone in severe polyposis" Arch Otolaryngol Head Neck Surg 125(5): 513 - 8, May 1998
14. Tos , M , Svendstrups, F , Arndal, H . "Efficacy of an aqueous and a powder formulation of nasal budesonide compared in patients with nasal polyps" Am J Rhinol 12(3): 183 - 9, June 1998
15. Lildholdt , T , Rundcrantz , H , Bende , M , Larsen , K . "Glucocorticoid treatment for nasal polyps. The use of topical budesonide powder, intramuscular betamethasone, and surgical treatment" Arch Otolaryngol Head Neck Surg 123(6): 595 - 600, June 1997
16. Karlsson, G , Rundcrantz , H . "A randomized trial of intranasal beclomethasone dipropionate after polypectomy" Rhinology 20(3): 144 - 148, September 1982
17. Mygind , N , Pedersen , C B, Prytz , S , Sorensen , H . "Treatment of nasal polyps with intranasal beclomethasone dipropionate aerosol" Clin Allergy 5(2): 159 - 164, June 1975
18. Virolainen , E , Puhakka, H . "The effect of intranasal beclomethasone dipropionate on the recurrence of nasal polyps after ethmoidectomy" Rhinology 18(1): 9 - 18, March 1980
19. Chalton, R , Mackay, I , Wilson, R , Cole, Cole . "Double blind, placebo controlled trial of betamethasone nasal drops for nasal polyposis" Br Med J (Clin Res Ed) 291(6498): 788, September 1985
20. Holopainen , E , Grahne , B , Malmberg , H , Makinien , J , Lindqvist, N . "Budesonide in the treatment of nasal polyposis" Eur J Respir Dis Suppl. 122, 221 - 228, 1982
21. Toft, A , Wihl, J A, Toxman, J , Mygind , N . "Double-blind comparison between beclomethasone dipropionate as aerosol and as powder in patients with nasal polyposis" Clin Allergy 12(4): 391 - 401, July 1982
22. Ruhno, J , Andersson, B , Denburg, J etal. "A double-blind comparison of intranasal budesonide with placebo for nasal polyposis" J Allergy Clin Immunol 86(6): 946 - 953, December 1990
23. Jankowski, R , Schrewelius, C , Bonfils, P , Saban, Y , Gilain, L , Prades, J M, Strunski, V . "Efficacy and tolerability of budesonide aqueous nasal spray treatment in patients with nasal polyps" Arch Otolaryngol Head Neck Surg 127(4): 447 - 452, 2001
24. Aukema, A A, Mulder, P G, Fokkens, W J. "Treatment of nasal polyposis and chronic rhinosinusitis with fluticasone propionate nasal drops reduces need for sinus surgery" J Allergy Clin Immunol 115(5): 1017 - 102, May 2005
25. Small, C B, Hernandez, J , Reyes, A , Schenkel, E , Damiano, A , Stryszak, P , Staudinger, H , Danzig, M . "Efficacy and safety of mometasone furoate nasal spray in nasal polyposis" J Allergy Clin Immunol 116(6): 1275 - 128, September 2005
26. Stjarne, P , Mosges, R , Jorissen, M , Passàli, D , Bellussi, L , Staudinger, H , Danzig, M . "A randomized controlled trial of mometasone furoate nasal spray for the treatment of nasal polyposis" Arch Otolaryngol Head Neck Surg 132(2): 179 - 185, February 2006
27. Stjarne, P , Blomgren, K , Cayé-Thomasen, P , Salo, S , Søderstrøm, T . "The efficacy and safety of once-daily mometasone furoate nasal spray in nasal polyposis: a randomized, double-blind, placebo-controlled study" Acta Otolaryngol 126(6): 606 - 612, June 2006