Nasal Corticosteroid Delivery Methods in Chronic Rhinosinusitis With Polyps: A Systematic Review

Area of Science:

• Otolaryngology
• Pharmacology
• Clinical Medicine

Background:

• Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly impacts quality of life.
• Intranasal corticosteroids (INCS) are a cornerstone therapy for CRSwNP.
• Various INCS delivery methods exist, necessitating a comparison of their efficacy and safety.

Purpose of the Study:

• To systematically review and compare the efficacy and safety of different intranasal corticosteroid delivery methods for CRSwNP.
• To evaluate the effectiveness of nebulizers, aerosol sprays, and nasal drops against oral corticosteroids (OCS).

Main Methods:

• Systematic search of Embase, CENTRAL, PubMed, and Web of Science databases (1980-2024).
• Inclusion of prospective randomized controlled trials (RCTs) comparing INCS delivery methods in CRSwNP patients.
• Exclusion of studies with inappropriate comparisons, interventions, populations, or administration routes.

Main Results:

• Five RCTs were included from 2282 initially identified studies.
• Non-aqueous delivery methods (nebulizer, aerosol spray, nasal drop) showed efficacy comparable to OCS with improved safety.
• Long-term use of aqueous sprays improved symptoms but was less effective than non-aqueous methods.

Conclusions:

• Non-aqueous INCS delivery methods (nebulizers, aerosol sprays, nasal drops) provide a safe alternative to OCS, avoiding systemic side effects.
• Long-term adherence to aqueous INCS formulations is crucial for achieving symptom improvement in CRSwNP patients.