A Short Course of Oral Prednisone Followed by Intranasal Budesonide Is an Effective Treatment of Severe Nasal Polyps

Benítez, Pedro; Alobid, Isam; Haro, Josep de; Berenguer, Joan; Bernal‐Sprekelsen, Manuel; Pujols, Laura; Picado, César; Mullol, Joaquim

doi:10.1097/01.mlg.0000205218.37514.0f

Cited by 95 publications

(76 citation statements)

References 14 publications

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“…Oral corticosteroids have traditionally been used for NP based on the observed clinical effect, despite the absence of supporting evidence from large, double-blind, randomized, placebo-controlled studies [8,59]. Two randomized placebo-controlled trials demonstrated the efficacy of a 2-week oral prednisolone treatment (30 mg/day for 4 days followed by a 2-day reduction of 5 mg/day [59] or 50 mg/day [60]) in improving nasal symptoms and significantly reducing polyp size.…”

Section: Resultsmentioning

confidence: 99%

Evidence-Based Management of Nasal Polyposis by Intranasal Corticosteroids: From the Cause to the Clinic

Bachert¹

2011

Int Arch Allergy Immunol

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Background: Nasal polyposis is an inflammatory disorder involving the mucosa of the nose and paranasal sinuses and affecting approximately 2–4% of the general population. Methods: A literature search of Medline and Embase was conducted to obtain an overview of the epidemiology, pathophysiology, and current treatment of nasal polyposis, focusing on evidence-based efficacy of intranasal corticosteroids (INSs) as primary and postoperative therapy. Recent research on INSs in nasal polyp treatment, along with notable historic findings, was reviewed. Results: Nasal polyps are mostly characterized by eosinophil infiltration, a complex inflammation of nasal mucosa, and possibly production of polyclonal IgE. Current treatment modalities include INSs, oral corticosteroids, and surgery; surgery is generally limited to those with an insufficient response to medical treatment. Because of their effects on eosinophil-dominated inflammation, INSs and oral corticosteroids are the primary medical treatment strategies. The very low (≤1%) systemic bioavailability of newer INSs minimizes the systemic adverse effects seen with oral corticosteroids. Conclusion:Based on randomized, controlled trials, guidelines recommend INSs as first-line therapy for nasal polyps and for care after polypectomy. Clinical data suggest INSs are effective in reducing polyp size and relieving nasal symptoms. INS treatment has also reduced nasal polyp recurrence in patients undergoing functional endoscopic sinus surgery. Treatment with these mainstay options has been found to improve quality of life, which, along with symptom improvement, is a key factor in disease treatment.

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Section: Resultsmentioning

confidence: 99%

Evidence-Based Management of Nasal Polyposis by Intranasal Corticosteroids: From the Cause to the Clinic

Bachert¹

2011

Int Arch Allergy Immunol

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“…The study design used herein has been previously reported [18]. After a 4-week washout period with no intranasal or oral steroids, patients were randomised (3:1) into two groups.…”

Section: Methodsmentioning

confidence: 99%

“…Severe nasal polyposis, atopy, asthma and aspirin sensitivity were diagnosed as described elsewhere [18,19] (see supplementary material). All subjects agreed to participate in the study, which was approved by the Ethics Committee of the Hospital Clinic from Barcelona (Spain).…”

Section: Study Subjectsmentioning

confidence: 99%

Glucocorticoid therapy increases COX-2 gene expression in nasal polyps in vivo

Pujols

Benítez²,

Alobid³

et al. 2008

European Respiratory Journal

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The aim of the present study was to evaluate the in vivo regulation of cyclooxygenase-2 in nasal polyps.In total, 65 patients with nasal polyps were randomly (3:1) treated with (n551; 33 with asthma) or without (n514) oral prednisone and intranasal budesonide for 2 weeks plus intranasal budesonide for 10 additional weeks. Biopsies were obtained at baseline and after 2 and 12 weeks of treatment. All samples were analysed for cyclooxygenase-1 and cyclooxygenase-2 mRNA. Attempts were made to detect cyclooxygenase-2 protein.At baseline, cyclooxygenase-1 and cyclooxygenase-2 expression did not differ between polyps from nonasthmatic and asthmatic patients. Cyclooxygenase-1 mRNA was unchanged by glucocorticoid treatment, while cyclooxygenase-2 mRNA increased in glucocorticoid-treated patients at week 2 compared with baseline and then decreased at week 12. Within subgroups, increased cyclooxygenase-2 mRNA was found at week 2 in polyps from nonasthmatic and asthmatic patients compared with baseline. At week 12, cyclooxygenase-2 expression remained high in nonasthmatics while it decreased in asthmatics. Cyclooxygenase-2 protein was not detected under any circumstances.Glucocorticoid therapy enhances cyclooxygenase-2 expression in vivo in nasal polyps, a finding that does not follow the generally accepted assumption that cyclooxygenase-2 expression is suppressed by glucocorticoids.

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“…Топическая кор-тикостероидная терапия имеет высший уровень доказа-тельности и клинических рекомендаций, так же как и си-стемная кортикостероидная терапия. В силу высокой (100%) биодоступности системных глюкокортикостерои-дов и, следовательно, риска развития побочных явлений, при ПРС следует проводить короткие курсы лечения си-стемными препаратами с последующим долгосрочным лечением местными ГКС [31].…”

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Chronic rhinosinusitis with nasal polyps. The recent trend in the studies of the pathogenesis, diagnosis and treatment of this disease

Козлов

Савлевич

2015

Vestn. otorinolaringol.

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A Short Course of Oral Prednisone Followed by Intranasal Budesonide Is an Effective Treatment of Severe Nasal Polyps

Abstract: A short course of oral steroids improved all nasal symptoms, polyp size, and nasal flow, whereas intranasal steroid maintain this effect.

Cited by 95 publications

References 14 publications

Evidence-Based Management of Nasal Polyposis by Intranasal Corticosteroids: From the Cause to the Clinic

Evidence-Based Management of Nasal Polyposis by Intranasal Corticosteroids: From the Cause to the Clinic

Glucocorticoid therapy increases COX-2 gene expression in nasal polyps in vivo

Chronic rhinosinusitis with nasal polyps. The recent trend in the studies of the pathogenesis, diagnosis and treatment of this disease

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