Oral Corticosteroid Regimens in the Management of Chronic Rhinosinusitis

Mansi, Ahmed; Bui, Roger; Chaaban, Mohamad R.

doi:10.1177/0145561319876906

Cited by 8 publications

(9 citation statements)

References 13 publications

(17 reference statements)

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“…This is consistent with Waljee et al., who defined short term as <30 days of corticosteroids 12 . Assuming an average total of 300 mg of prednisone per course, this would expose the patient to about 900 mg yearly 3,5,16 . This dose would put patients at risk for AVN even with “short‐term” use.…”

Section: Discussionsupporting

confidence: 79%

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Oral corticosteroid use and the risk of developing avascular necrosis: A large retrospective review

Grond

Little

Campbell

et al. 2022

Int Forum Allergy Rhinol

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Introduction The risk of adverse events, specifically avascular necrosis (AVN), associated with corticosteroid use is not well reported. The aim of this study was to evaluate the prevalence of AVN among patients with prior oral corticosteroid administration. Methods An institutional database query recognized 113,734 adult patients with oral corticosteroid administration between January 2006 and May 2017. A temporal query performed on this cohort determined that 789 had a diagnosis of AVN following oral corticosteroids. A retrospective review was performed on this cohort. Data collected included demographics, comorbidities, date of initial oral corticosteroid exposure, and time to diagnosis of AVN. Records without radiographic confirmation of AVN were excluded from analysis. Patients with cumulative lifetime dosages greater than 10,000 mg prednisone were excluded from analysis. Results A total of 789 patients with oral corticosteroid use prior to diagnosis of AVN were identified. Five hundred and seventy‐two patients were excluded due to insufficient documentation of oral corticosteroid dosage, no radiographic evidence supporting the diagnosis of AVN, insufficient data confirming the temporal relationship between oral corticosteroids and AVN, and/or a cumulative dosing of >10,000 mg prednisone. This left 217 patients included in the analysis. The mean duration of use prior to diagnosis of AVN was 219 (± 374) days, and mean cumulative dose was 3314 (± 2908) mg prednisone equivalents. Mean time between diagnosis of AVN and onset of pathologic fracture was 379 (± 1046) days. Conclusion For patients receiving low cumulative doses of oral corticosteroids, corticosteroids pose a small risk of development of AVN. More studies are required to better characterize risk.

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Section: Discussionsupporting

confidence: 79%

“…12 Assuming an average total of 300 mg of prednisone per course, this would expose the patient to about 900 mg yearly. 3,5,16 This dose would put patients at risk for AVN even with "short-term" use.…”

Section: Discussionmentioning

confidence: 99%

Oral corticosteroid use and the risk of developing avascular necrosis: A large retrospective review

Grond

Little

Campbell

et al. 2022

Int Forum Allergy Rhinol

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“…Statement 31 regarding using the lowest effective dose of systemic corticosteroids achieved high consensus, but panelists were not unanimous. There is a lack of dosing recommendations and thus a wide variation in OCS doses prescribed to patients with CRS (with or without polyps), ranging from 15 mg/day to 1 mg/kg/day (total doses 150–352 mg) [ 81 ]. Neither European nor international CRSwNP guidelines provide dosing recommendations for OCS in CRSwNP [ 1 , 32 , 81 ], indicating a need for further study to establish the optimal dose [ 81 ].…”

Section: Resultsmentioning

confidence: 99%

Personalized Management of Patients with Chronic Rhinosinusitis with Nasal Polyps in Clinical Practice: A Multidisciplinary Consensus Statement

Corso

Bilò

Matucci

et al. 2022

JPM

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Chronic rhinosinusitis (CRS) is a sino-nasal chronic inflammatory disease, occurring in 5–15% of the general population. CRS with nasal polyps (CRSwNP) is present in up to 30% of the CRS population. One-third of CRSwNP patients suffer from disease that is uncontrolled by current standards of care. Biologics are an emerging treatment option for patients with severe uncontrolled CRSwNP, but their positioning in the treatment algorithm is under discussion. Effective endotyping of CRSwNP patients who could benefit from biologics treatment is required, as suggested by international guidelines. Other issues affecting management include comorbidities, such as allergy, non-steroidal anti-inflammatory drug–exacerbated respiratory disease, and asthma. Therefore, the choice of treatment in CRSwNP patients depends on many factors. A multidisciplinary approach may improve CRSwNP management in patients with comorbidities, but currently there is no shared management model. We summarize the outcomes of a Delphi process involving a multidisciplinary panel of otolaryngologists, pulmonologists, and allergist-immunologists involved in the management of CRSwNP, who attempted to reach consensus on key statements relating to the diagnosis, endotyping, classification and management (including the place of biologics) of CRSwNP patients.

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“…Many authors, however, highlight the importance of monitoring the total dose instead. 34,35 Brescia et al 19 managed participants with CRSwNPs for 36 months postoperatively, either by INCS or two cycles of OCS, and did not find any significant difference between the groups regarding recurrences. 19 Because RCTs that compare INCS and OCS head-to-head are exceptional, we ascribe importance to the literature, 19 the results of which are similar to ours.…”

Section: Discussionmentioning

confidence: 96%

Methotrexate for recurrent chronic rhinosinusitis with nasal polyps: A randomized, controlled, phase 2 clinical trial

Çetin

Tunçok

Keskįnoğlu

et al. 2023

Int Forum Allergy Rhinol

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ObjectiveThis randomized, controlled, open‐label, phase 2 clinical trial aimed to assess the efficacy and safety of low‐dose methotrexate as maintenance therapy for recurrent postoperative chronic rhinosinusitis with nasal polyps (CRSwNPs).MethodsForty‐one patients with CRSwNPs who experienced postoperative polyp recurrence(s) were randomly divided into three groups to receive one of the following treatments for 8 weeks: daily intranasal mometasone furoate monohydrate 200 mcg (control [intranasal corticosteroids (INCS)] arm, n = 13]); daily per oral methylprednisolone 8 mg (oral corticosteroids [OCS] arm, n = 14); and once weekly per oral 10 mg methotrexate (MTX arm, n = 14). All patients were assessed at three clinical visits according to the Lund‐Kennedy endoscopic grading system (LKES), visual analog scale (VAS), Turkish version of the Sinonasal Outcome Test‐22 (SNOT‐22), peak nasal inspiratory flow (PNIF), butanol olfactory threshold test (BuOT), serum total IgE level, presence of peripheral eosinophilia, serum biochemical assays, and adverse events.ResultsAll efficacy outcome measures significantly improved in all three groups, except for the nonrecovery of peripheral eosinophilia in the INCS group. There was no significant difference among the groups in terms of LKES scores. Scores for the Turkish version of the SNOT‐22, PNIF, BuOT, and serum IgE levels were also similar among the groups. However, total VAS scores recovered significantly better in the INCS group than in the MTX group. Serum biochemical assays remained normal in all groups. Adverse events were minor and observed only in the OCS group.ConclusionLow‐dose MTX was a safe and effective maintenance therapy for patients with recurrent postoperative CRSwNPs.

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Oral Corticosteroid Regimens in the Management of Chronic Rhinosinusitis

Cited by 8 publications

References 13 publications

Oral corticosteroid use and the risk of developing avascular necrosis: A large retrospective review

Oral corticosteroid use and the risk of developing avascular necrosis: A large retrospective review

Personalized Management of Patients with Chronic Rhinosinusitis with Nasal Polyps in Clinical Practice: A Multidisciplinary Consensus Statement

Methotrexate for recurrent chronic rhinosinusitis with nasal polyps: A randomized, controlled, phase 2 clinical trial

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