Fluticasone furoate nasal spray is more effective than fexofenadine for nighttime symptoms of seasonal allergy

Abstract

Nasal symptoms of allergic rhinitis are an important cause of sleep disturbance. Reduction of nasal symptoms, particularly nasal obstruction, has been linked to improvements in self-reported sleep quality. The enhanced-affinity intranasal corticosteroid fluticasone furoate and the oral antihistamine fexofenadine were compared with respect to nighttime symptoms of seasonal allergic rhinitis. In two randomized, double-blind, double-dummy, parallel-group studies, patients received fluticasone furoate nasal spray (FFNS),110 microg (study 1, n = 312; study 2, n = 224); fexofenadine, 180 mg (study 1, n = 311; study 2, n = 227); or placebo (study 1, n = 313; study 2, n = 229) once daily for 2 weeks. Fluticasone furoate was more effective (p < 0.001) than fexofenadine and placebo in both studies with respect to the mean changes from baseline over the treatment period in the nighttime symptoms score, nighttime reflective total nasal symptom score, predose instantaneous nasal symptom score, and morning peak nasal inspiratory flow. Fluticasone furoate was more effective than placebo (p <or= 0.001) in study 1 and more effective than both placebo and fexofenadine (p <or= 0.034) in study 2 with respect to the mean changes from baseline in the nighttime reflective total ocular symptom score and predose instantaneous total ocular symptom score. In these double-dummy studies, fexofenadine did not separate from placebo in comparisons of the nighttime symptoms score or the nighttime nasal or ocular symptom measures. The incidence of adverse events was similar among groups. FFNS once daily was more effective than fexofenadine and placebo with respect to nighttime sleep disturbance caused by seasonal allergy symptoms.

Are intranasal corticosteroids all equally consistent in managing ocular symptoms of seasonal allergic rhinitis?

“…FFNS has also been investigated by Andrews et al, 2009, in two studies in comparison with placebo and the antihistamine fexofenadine 38,39 . In these studies, FFNS 110 mg once daily (combined n ¼ 992) was significantly more effective than placebo with respect to mean change from baseline to endpoint in night-time, daytime and 24-hour rTOSS (LS mean difference for all comparisons: 5À0.4, p50.007 and À0.4, p ¼ 0.034 for Study FFU109045 and FFU109047, respectively) and pre-dose iTOSS (LS mean difference: À0.5, p50.001 and À0.4, p ¼ 0.014 for Study FFU109045 and FFU109047, respectively) 38,39 .…”

Mometasone furoate nasal spray reduces the ocular symptoms of seasonal allergic rhinitis

“…In 5 recent placebo-controlled studies, FF significantly improved iTOSSs. 30,31,[63][64][65] However, the absence of data for individual ocular symptoms in 4 of these studies has been cited as a weakness in their findings. 66 One study did show that FF significantly improved all individual morning symptoms.…”

Should Intranasal Corticosteroids Be Used for the Treatment of Ocular Symptoms of Allergic Rhinoconjunctivitis? A Review of Their Efficacy and Safety Profile

“…The favorable effect of INSs on ocular symptoms [44] was supported by recent studies which included treatment with INSs agents: mometasone furoate (MF) [18,19,20,21], fluticasone furoate (FF) [22,23,24,25,26,27,28], fluticasone propionate (FP) [29,30], budesonide [31], and (to some degree) triamcinolone acetonide (TA) [32] and beclomethasone dipropionate (BDP) aqueous nasal spray [33,34]. However, the effects of INSs on ocular symptoms were inconsistent across some separate studies [37,40].…”

“…FFNS provided consistent positive effects on the ocular symptoms of SAR, compared with placebo, across the 6 prospective trials [22,23,24,25,26,27,28,45]. These effects were consistent across different allergy seasons and geographic locations, and were considered to be robust owing to the consistent use of ocular symptom scores to determine ocular efficacy [45].…”

“…Evidence obtained more recently increasingly suggests that INSs may be effective in alleviating ocular symptoms (e.g. eye watering) [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35]. …”