Nonallergic rhinitis: Cochrane review finds uncertain benefit from intranasal corticosteroids

  • Segboer C & al.
  • Cochrane Database Syst Rev
  • 2 Nov 2019

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Heterogeneity across studies.
  • Lack of comparative clinical trials.