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Intranasal corticosteroids for non-allergic rhinitis.
Christine Segboer1, Artur Gevorgyan2, Klementina Avdeeva1
1Academic Medical Centre, Department of Otorhinolaryngology, Meibergdreef 9, A2-234, 1105 Az, Amsterdam, Netherlands.
The Cochrane Database of Systematic Reviews
|November 3, 2019
Summary
Intranasal corticosteroids may offer slight symptom relief for non-allergic rhinitis up to four weeks, but evidence beyond that is uncertain. Patients using these treatments likely face a higher risk of nosebleeds (epistaxis).
Area of Science:
- Otolaryngology and Allergy Research
- Pharmacological Interventions for Nasal Conditions
Background:
- Non-allergic rhinitis affects 10-20% of the population, characterized by nasal inflammation and symptoms like obstruction and sneezing, often lacking effective treatments due to poor understanding of disease mechanisms.
- Intranasal corticosteroids are commonly prescribed for rhinitis symptoms, but their efficacy in non-allergic rhinitis remains unclear.
Purpose of the Study:
- To systematically assess the effectiveness and safety of intranasal corticosteroids in managing non-allergic rhinitis.
Main Methods:
- A comprehensive search of multiple databases was conducted for randomized controlled trials (RCTs) comparing intranasal corticosteroids with placebo or other active treatments in individuals aged 12 years and older.
- Primary outcomes included patient-reported disease severity and epistaxis; secondary outcomes encompassed quality of life, airflow measurements, and other adverse events.
- Data were analyzed using standardized mean differences (SMD) and risk ratios (RR), with the certainty of evidence assessed using GRADE methodology.
Main Results:
- Thirteen studies (2045 participants) comparing intranasal corticosteroids to placebo showed low-certainty evidence for improved patient-reported disease severity at up to four weeks (SMD -0.74).
- Evidence for symptom improvement beyond four weeks was very uncertain (SMD -0.24).
- A moderate-certainty evidence indicated a probable higher risk of epistaxis with intranasal corticosteroids (RR 2.10), with a number needed to treat for an additional harmful outcome (NNTH) of 25.
Conclusions:
- The certainty of evidence regarding the effectiveness of intranasal corticosteroids for non-allergic rhinitis is generally low to very low.
- While short-term symptom improvement may occur, intranasal corticosteroids are associated with an increased risk of epistaxis.
- Limited studies comparing intranasal corticosteroids to other treatments preclude definitive conclusions on their relative efficacy.
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