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WITHDRAWN: Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis
Peta-Lee Sacks1, Richard J Harvey, Janet Rimmer
1St Vincent's Clinical School, St Vincent's Hospital, 806/438 Victoria St, Darlinghurst, Sydney, Australia, NSW 2010.
Background:
Chronic rhinosinusitis (CRS) is an inflammatory disorder of the nose and sinuses. Since fungi were postulated as a potential cause of CRS in the late 1990s, there has been increasing controversy about the use of both topical and systemic antifungal agents in its management. Although interaction between the immune system and fungus has been demonstrated in CRS, this does not necessarily imply that fungi are the cause of CRS or that antifungals will be effective its management.
Objectives:
To assess the effectiveness of topical or systemic antifungal therapy in the treatment of CRS.
Search Methods:
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 8 March 2011.
Selection Criteria:
All randomised, placebo-controlled trials considering the use of topical or systemic antifungal therapy in the treatment of CRS and allergic fungal sinusitis (AFS). CRS was defined using either the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) or American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) criteria.
Data Collection And Analysis:
We reviewed the titles and abstracts of all studies obtained from the searches and selected trials that met the eligibility criteria. We extracted data using a pre-determined data extraction form. There was significant heterogeneity of outcome data reporting with reports containing both parametric and non-parametric representations of data for the same outcomes. Means and standard deviations for change data were unavailable for a number of trials. Due to the limited reported data, we contacted authors and used original data for data analysis.
Main Results:
Six studies were included (380 participants). Five studies investigated topical antifungals and one study investigated systemic antifungals. The risk of bias in all included studies was low, with all trials being double-blinded and randomised. Pooled meta-analysis showed no statistically significant benefit of topical or systemic antifungals over placebo for any outcome. Symptom scores in fact statistically favoured the placebo group. Adverse event reporting was statistically significantly higher in the antifungal group.
Authors' Conclusions:
On the basis of this meta-analysis, there is no evidence to support the use of either topical or systemic antifungal treatment in the management of CRS.
Insights
Antifungal treatments do not improve chronic rhinosinusitis (CRS) symptoms. This review found no evidence that topical or systemic antifungals are effective for CRS management, with placebo showing better results.
Area of Science:
- Otolaryngology
- Immunology
- Pharmacology
Background:
- Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition affecting the nose and sinuses.
- Fungal involvement in CRS has been debated since the late 1990s, leading to controversy regarding antifungal therapies.
- While immune system interactions with fungi in CRS are documented, causality and treatment efficacy remain unclear.
Purpose of the Study:
- To evaluate the effectiveness of topical or systemic antifungal therapy for chronic rhinosinusitis (CRS).
Main Methods:
- A comprehensive search of multiple databases was conducted for randomized, placebo-controlled trials (RCTs) up to March 2011.
- Included trials focused on topical or systemic antifungal use in CRS and allergic fungal sinusitis (AFS), adhering to established diagnostic criteria.
- Data extraction and analysis involved contacting authors for missing information due to heterogeneity in outcome reporting.
Main Results:
- Six double-blind, randomized, low-risk-of-bias studies with 380 participants were included.
- Pooled meta-analysis revealed no statistically significant benefit of antifungal treatments (topical or systemic) over placebo for any outcome.
- Symptom scores favored the placebo group, and adverse events were significantly higher in the antifungal group.
Conclusions:
- Current evidence from this meta-analysis does not support the use of topical or systemic antifungal treatments for managing chronic rhinosinusitis (CRS).
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