Intranasal Corticosteroid Therapy: Systematic Review and Meta‐analysis of Reported Safety and Adverse Effects in Adults

Donaldson, Angela M.; Choby, Garret; Kim, Daniel H.; Marks, Lisa; Lal, Devyani

doi:10.1177/0194599820931455

Cited by 21 publications

(22 citation statements)

References 62 publications

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“…While the systematic review and meta-analysis from 2020 showed that INCSs in adults are generally safe, 40 concerns have been raised about the potential adverse events of chronic INCS use on growth in children, 41 , 42 despite conflicting evidence for this being available in published studies. For example, use of BDP ANS (168 µg BID) was shown to significantly affect growth rate in children after one year of treatment, 43 and BUD MDI (200 μg BID) was found to significantly reduce lower-leg growth in children after six weeks of treatment.…”

Section: Introductionmentioning

confidence: 99%

Intranasal Corticosteroids: Topical Potency, Systemic Activity and Therapeutic Index

Daley‐Yates¹,

Larenas‐Linnemann²,

Bhargave³

et al. 2021

JAA

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Intranasal corticosteroid (INCS) therapy is the preferred treatment option for allergic rhinitis (AR). Although all INCSs for the treatment of AR are considered safe and effective, differences in potency, molecular structure features and physicochemical and pharmacokinetic properties could result in differences in clinical efficacy and safety. Higher glucocorticoid receptor (GR) binding affinity of INCS is associated with higher lipophilicity, nasal tissue retention and topical potency. Higher topical potency is also accompanied by low oral bioavailability and high systemic clearance conferring low systemic exposure, reduced potential for systemic adverse effects and an improved therapeutic index. It has been shown that adverse events related to systemic exposure of INCSs in children are low. Although INCSs mostly produce low systemic effects, use of an INCS with low systemic exposure in patients on multiple corticosteroid (CS) therapies could help reduce the total systemic burden of CS therapy. Despite differences in topical potency, physicochemical and pharmacokinetic properties between INCSs, clinical studies of INCSs in the treatment of AR generally show no clinically important differences between these compounds, and poor correlation between INCS topical potency and clinical response. However, the lack of head-to-head comparisons of INCSs in clinical studies conducted in more severe AR patients should be noted. This narrative review provides an assessment of the therapeutic relevance of topical potency and the physicochemical and pharmacokinetic properties of INCSs and describes for the first time the relationship between topical potency and therapeutic index using pharmacological features of INCSs. It concludes that higher GR binding affinity and topical potency can potentially improve the therapeutic index of an INCS. Therefore, both efficacy and systemic exposure profiles should be considered when comparing INCS regimens in terms of therapeutic equivalence, to aid clinical decision-making and avoid the assumption that all INCS formulations are the same when considering treatment options.

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Section: Introductionmentioning

confidence: 99%

Intranasal Corticosteroids: Topical Potency, Systemic Activity and Therapeutic Index

Daley‐Yates¹,

Larenas‐Linnemann²,

Bhargave³

et al. 2021

JAA

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“…Glucocorticoids are applied not only systemically but also locally as intranasal corticoids spray. Especially the intranasal administration is one of the first choices of conservative treatments of CRS and AR due to its confirmed efficacy and safety (47)(48)(49).…”

Section: Glucocorticoidsmentioning

confidence: 99%

TLR Signals in Epithelial Cells in the Nasal Cavity and Paranasal Sinuses

et al. 2021

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The respiratory tract is constantly at risk of invasion by microorganisms such as bacteria, viruses, and fungi. In particular, the mucosal epithelium of the nasal cavity and paranasal sinuses is at the very forefront of the battles between the host and the invading pathogens. Recent studies have revealed that the epithelium not only constitutes a physical barrier but also takes an essential role in the activation of the immune system. One of the mechanisms equipped in the epithelium to fight against microorganisms is the Toll-like receptor (TLR) response. TLRs recognize common structural components of microorganisms and activate the innate immune system, resulting in the production of a plethora of cytokines and chemokines in the response against microbes. As the epithelia-derived cytokines are deeply involved in the pathogenesis of inflammatory conditions in the nasal cavity and paranasal sinuses, such as chronic rhinosinusitis (CRS) and allergic rhinitis (AR), the molecules involved in the TLR response may be utilized as therapeutic targets for these diseases. There are several differences in the TLR response between nasal and bronchial epithelial cells, and knowledge of the TLR signals in the upper airway is sparse compared to that in the lower airway. In this review, we provide recent evidence on TLR signaling in the upper airway, focusing on the expression, regulation, and responsiveness of TLRs in human nasal epithelial cells (HNECs). We also discuss how TLRs in the epithelium are involved in the pathogenesis of, and possible therapeutic targeting, for CRS and AR.

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“…19,20 A meta-analysis and systematic review by Donaldson et al of 60 studies concluded that INCS are safe in the adult population. 21 High-volume irrigations. Given the well-documented increase in sinus penetration with high-volume irrigations, particularly in postoperative cases, the off-label use of budesonide irrigations has become increasingly popular in CRS treatment.…”

Section: Delivery Devicesmentioning

confidence: 99%

A Scholarly Review of the Safety and Efficacy of Intranasal Corticosteroids Preparations in the Treatment of Chronic Rhinosinusitis

Macias-Valle

Psaltis

2020

Ear Nose Throat J

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Objective: The purpose of this scholarly review is to present an update of the efficacy, safety, and distribution of intranasal corticosteroids (INCS) in the context of treatment for chronic rhinosinusitis (CRS). Materials and Methods: A literature review from 1999 to 2020 of MEDLINE, PubMed, and EMBASE databases was performed, using a comprehensive search strategy. Studies reporting on efficacy, safety, and distribution of all INCS formulations, both Food and Drug Administration (FDA) and non-FDA approved, were reviewed. Results and Conclusions: High-level evidence publications and position papers support the role of INCS in medical treatment for CRS. Significant improvement in disease-specific and general quality of life measures is observed with all formulations of INCS. Overall, the use of both FDA and published non-FDA INCS appears to be safe. Several novel distribution devices might improve penetration to specific areas within the sinuses.

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Intranasal Corticosteroid Therapy: Systematic Review and Meta‐analysis of Reported Safety and Adverse Effects in Adults

Cited by 21 publications

References 62 publications

Intranasal Corticosteroids: Topical Potency, Systemic Activity and Therapeutic Index

Intranasal Corticosteroids: Topical Potency, Systemic Activity and Therapeutic Index

TLR Signals in Epithelial Cells in the Nasal Cavity and Paranasal Sinuses

A Scholarly Review of the Safety and Efficacy of Intranasal Corticosteroids Preparations in the Treatment of Chronic Rhinosinusitis

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