- A Cochrane review finds uncertain benefit from inhaled corticosteroids (vs placebo) for nonallergic rhinitis.
- It does find higher risk for epistaxis as an adverse event.
Why this matters
- Findings run counter to common medical practice for which inhaled corticosteroids are the norm.
- Review and meta-analysis of 13 randomised controlled trials (n=2045) in which intranasal corticosteroids were compared with placebo after search of PubMed, Cochrane ENT Register, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL, among others.
- Funding: National Institute for Health Research; Cochrane ENT funding.
- No studies followed patients past 3 months.
- Follow-up ≤4 weeks:
- Intranasal corticosteroids (vs placebo) had more favourable disease severity, as measured by patient-reported symptom score (standardised mean difference [SMD], −0.74; 95% CI, −1.15 to −0.33; I2=22%), but evidence is of low certainty.
- Follow-up from 4 weeks to up to 3 months:
- Intranasal corticosteroids (vs placebo) had no different disease severity, as measured by patient-reported symptom score (SMD, −0.24; 95% CI, −0.67 to 0.20; I2=0%), but evidence is of very low certainty.
- Intranasal corticosteroids were associated with higher risk for epistaxis (65/1000 vs 31/1000 with placebo; risk ratio, 2.10; 95% CI, 1.24-3.57), with evidence of moderate certainty.
- Heterogeneity across studies.
- Lack of comparative clinical trials.