As-needed intranasal corticosteroid spray for allergic rhinitis: a systematic review and meta-analysis

Abstract

Background: As-needed intranasal corticosteroid spray (INCS) is commonly used by patients with allergic rhinitis (AR) who have suboptimal symptom control. This systematic review aimed to assess the effectiveness of as-needed INCS for treating AR. Methodology: Systematic searches for randomized controlled trials studying the effects of as-needed INCS compared to regular INCS, as-needed antihistamine, or placebo were performed. Primary outcomes were total nasal symptom score (TNSS) and disease-specific quality of life (DSQoL). Results: Eight studies (882 participants) met the criteria. Regular use of INCS showed greater improvements than as-needed INCS in TNSS, DSQoL, nasal peak inspiratory flow, sneezing, and nasal congestion scores with small effect sizes. There were no differences between regular and as-needed INCS usage for ocular symptoms, symptom-free days, nasal itching, and rhinorrhea scores. As-needed INCS was superior to as-needed antihistamine and placebo with medium effect sizes. There were no differences in risk of adverse events between the groups in all three comparisons. Conclusions: Regular use of INCS improved total nasal symptoms score and DSQoL better than as-needed INCS. However, as-needed INCS improved TNSS better than as-needed antihistamine and placebo. The effects of as-needed INCS were closer to regular INCS usage than to placebo or as-needed AH usage.

Global expert views on the diagnosis, classification and pharmacotherapy of allergic rhinitis in clinical practice using a modified Delphi panel technique

“…The promise of PRN therapy in managing AR is supported by recent updates to AR guidelines 1 and recent clinical studies. 19 , 28 , 29 , 30 , 31 , 32 Additional descriptive analyses have also been carried out. 31 Two analyses by the Mobile Airways Sentinel Network (MASK) 28 , 29 , 30 were designed to utilise data from more than 9000 users from 22 countries, confirming results from a pilot study.…”

“… 1 A recent systematic review was designed to assess the effectiveness of PRN INCS for treating AR. 32 Eight studies involving a total of 882 participants met the criteria. 19 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 While regular INCS use improved TNSS and disease-specific quality of life more than PRN INCS, PRN INCS improved TNSS more than PRN antihistamine and placebo.…”

Pharmacology, particle deposition and drug administration techniques of intranasal corticosteroids for treating allergic rhinitis

“…A meta‐analysis concludes that based on their results, INCs are not associated with a significant increased risk of elevating the intraocular pressure (relative risk 2.24 [95% CI: 0.68–7.34, 494 studies]) or developing cataracts (absolute increased incidence 0.02% [95% CI: −0.3% to 0.4%, 494 studies]). An association with the risk of occurrence of glaucoma cannot be ruled out 13 . The association between INCs and the occurrence of chorioretinopathy is rare 39 .…”

“… 9 , 10 For mild‐to‐moderate AR symptoms, INC therapy is not recommended, although studies have suggested that INCs may be effective as as‐needed therapy for mild AR symptoms, compared with placebo and antihistamines. 11 , 12 , 13 Hoang et al 13 emphasize that regular use of INCs provides greater benefits than the as‐needed therapy in total nasal symptoms score and disease‐specific QoL.…”

“…An association with the risk of occurrence of glaucoma cannot be ruled out. 13 The association between INCs and the occurrence of chorioretinopathy is rare. 39 A limitation of most of these studies is the short study period (maximum 1 year).…”