Comparison of Corticosteroids by 3 Approaches to the Treatment of Chronic Rhinosinusitis With Nasal Polyps

Abstract

Purpose Corticosteroids are regarded as the mainstay of medical treatment of eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP). To date, a head-to-head comparison of the efficacy and safety of glucocorticoid preparations administered via different routes for the treatment of chronic rhinosinusitis with nasal polyps has not been reported. To compare the efficacy and safety of steroids administered via the oral, intranasal spray and transnasal nebulization routes in the management of ECRSwNP over a short course. Methods Overall, 91 patients with ECRSwNP were recruited prospectively and randomized to receive either oral methylprednisolone, budesonide inhalation suspension (BIS) via transnasal nebulization, or budesonide nasal spray (BNS) for 2 weeks. Nasal symptoms and polyp sizes were assessed before and after the treatment. Similarly, nasal polyp samples were evaluated for immunological and tissue remodeling markers. Serum cortisol levels were assessed as a safety outcome. Results Oral methylprednisolone and BIS decreased symptoms and polyp sizes to a significantly greater extent from baseline ( P < 0.05) than BNS. Similarly, BIS and oral methylprednisolone significantly reduced eosinophils, T helper 2 cells, eosinophil cationic protein, interleukin (IL)-5, and expression of matrix metalloproteinases 2 and 9, and significantly increased type 1 regulatory T cells, IL-10, transforming growth factor-β, and tissue inhibitor of metalloproteinases 1 and 2 in nasal polyps to a greater extent than BNS. Post-treatment serum cortisol levels were significantly decreased by oral methylprednisolone compared to BIS or BNS, which did not significantly alter the cortisol levels. Conclusions A short course of BIS transnasal nebulization is more efficacious compared to BNS in the management of ECRSwNP and is safer than oral methylprednisolone with respect to hypothalamic-pituitary-adrenal axis function.

Particulate Matter 2.5 Causes Deficiency in Barrier Integrity in Human Nasal Epithelial Cells

“…INS have been proven to be effective in the treatment of nasal inflammation and in protecting barrier function against different types of stimulations 3141516. In order to investigate if a topical steroid could prevent the PM2.5-induced damage to the epithelial barrier, budesonide (1 μmol/L) was applied to ALI-cultured NECs,1 hour before exposure to PM2.5.…”

“…INSs have been proven to be effective in the treatment of nasal inflammation, particularly allergic rhinitis, through different mechanisms 141516. The protective role of glucocorticoid on TJs was controversial 3.…”

Efficacy of Dupilumab in Concomitant Atopic Dermatitis and Chronic Rhinosinusitis With Nasal Polyps: A Preliminary Study

“…At screening, patients must have a bilateral endoscopic nasal polyp score (NPS) 5 of at least one of the following symptoms and exhibit at least two of the following symptoms: nasal congestion or obstruction and either loss of smell or nasal discharge (anterior or posterior).…”

Biology and Function of Eosinophils in Chronic Rhinosinusitis With or Without Nasal Polyps

“…Corticosteroids (both intranasal and oral) have been associated with significant reductions in eosinophil numbers as well as with reductions in ECP and IL-5 levels in nasal polyps. 51 52 Given the widespread mechanisms of action, it remains unclear if the clinical benefits of corticosteroids observed in CRSwNP are predominantly mediated solely through the reduction of eosinophils (which seems unlikely) or instead through a combination of this and other anti-inflammatory effects.…”