Oral plus topical steroids may help with nasal polyposis

January 01, 0001

Oral plus topical steroids may help with nasal polyposis

Chronic rhinosinusitis (CRS) with nasal polyposis is common. The long-term efficacy and safety of approaches to medical management are not well-known. The aim of this study by researchers from Scotland was to evaluate the efficacy and safety of a 2-week regimen of oral steroid therapy followed by 26 weeks of sequential topical steroid maintenance therapy. It consisted of a blinded parallel randomized trial in a specialty rhinology clinic with 60 adults with CRS and moderate-sized or larger nasal polyps referred by their primary physicians for specialty care. Patients were randomly assigned in a 1:1 ratio to receive oral prednisolone, 25 mg/d, or placebo for 2 weeks, followed in both groups by fluticasone propionate nasal drops, 400 mcg twice daily, for 8 weeks and then fluticasone propionate nasal spray, 200 mcg twice daily, for 18 weeks.

The mean decrease in polyp grade from baseline to 2 weeks was 2.1 units in the prednisolone group and 0.1 unit in the placebo group (mean difference between groups, -1.8 units, significant). The difference between groups was -1.08 units (significant) at 10 weeks and -0.8 unit (not significant) at 28 weeks. The mean decrease in hyposmia score from baseline to 2 weeks was 31.12 mm in the prednisolone group and 1.41 mm in the placebo group (mean difference between groups, -28.33 mm, significant). The difference between groups was -16.06 mm (significant) at 10 weeks and -12.13 mm (not significant) at 28 weeks. Prednisolone therapy resulted in transient suppression of adrenal function and increase in bone turnover after 2 weeks, with a return to baseline at 10 and 28 weeks.

The researchers concluded: "Initial oral steroid therapy followed by topical steroid therapy seems to be more effective over 6 months than topical steroid therapy alone in decreasing polyp size and improving olfaction in patients referred for specialty care of CRS with at least moderate nasal polyposis."

Probably best decided by the specialists due to steroid concerns.

For the full abstract, click here.

Ann Intern Med 154:365-367, 1 March 2011 © 2010 by the American College of Physicians
Treatment of Chronic Rhinosinusitis With Nasal Polyposis With Oral Steroids Followed by Topical Steroids: A Randomized Trial. Sriram Vaidyanathan, Martyn Barnes, Peter Williamson et al.

Category: H. Ear. Keywords: chronic, rhinosinusitis, nasal, polyposis, oral, topical, steroids, randomized trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 18 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.