Nasal steroids offer acute sinusitis relief
MedWire News: Nasal steroids can relieve symptoms of acute sinusitis, especially facial pain and congestion, although they are slow to take effect and the benefits are relatively small, research shows.
The findings come from a meta-analysis of clinical trials conducted by researchers at Oxford University, UK, and published in the Annals of Family Medicine.
The analysis of six studies, including a total of 2495 patients from the UK, Turkey and the USA, revealed that intranasal corticosteroids led to a significant increase in the resolution or improvement of symptoms after 14 to 21 days, relative to placebo.
Overall the benefit was small, however, with 73% of patients receiving the nasal steroids experiencing improvement or resolution of symptoms by 2-3 weeks compared with 66% of patients on placebo, giving a number needed to treat (NNT) of 13.
Furthermore, outcome timing data available for three studies indicated that the benefit only emerged at 21 days of follow-up, with no significant between-group difference at 14-15 days.
In three trials that reported individual symptom scores, the most consistent symptom improvements seen were for relief of face pain and congestion. Indeed, patients who received intranasal mometasone furoate reported significantly greater improvement in facial pain and congestion in all three trials, while improvement in rhinorrhea was reported in two trials, and headache and postnasal drip each improved in just one trial.
Further analysis of these three trials showed a significant dose-response relationship for mometasone furoate; among patients receiving 800 µg the NNT was 8, while for those on 400 µg the NNT was 14.
Study authors Gail Hayward and colleagues conclude that the overall 7% risk difference "is a relatively small increase in the context of a self-limiting condition, and this clinical benefit must be set against potential harms and economic implications."
Nevertheless, they suggest that use of nasal steroids could potentially limit prescriptions of antibiotics for acute sinusitis, which are still widely prescribed despite little evidence of any benefit.
On the other hand, John Hickner, from Case Western Reserve School of Medicine in Cleveland, Ohio, USA, argues in a related editorial that "most patients want to get better in a few days, not 3 weeks", and that over-the-counter drugs such as ibuprofen and pseudoephedrine offer similar relief "at a fraction of the cost."
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By Caroline Price