Fluticasone Spray Useful as Acute and Long-Term Therapy for Nasal Polyposis
July 17, 2009 — Fluticasone propionate nasal spray (FPANS) at 200 micrograms twice a day is an effective acute treatment for nasal polyposis, new research shows. At 200 micrograms once a day, it is useful for long-term control.
Nasal polyposis is due to chronic inflammation of the mucosa lining of the nasal and paranasal sinus. The diagnosis is characterized the presence of polyps on endoscopy and at least two of the following symptoms: nasal blockage, facial pain, rhinorrhea, or hyposmia.
The optimal treatment of nasal polyposis has been the subject of debate for many decades, lead author Dr. Roger Jankowski, from Hopital Central de Nancy, France, and colleagues explain. In a 2007 update, the European Position Paper on Nasal Polyposis recommended topical steroid therapy as first-line treatment, based on findings from several randomized controlled trials of fluticasone and other steroids.
Despite this recommendation, there has been limited data regarding the long-term efficacy and tolerability of steroid therapy for nasal polyposis, according to the report in the June issue of Allergy.
The present study tested three FPANS treatment periods: 1 month of acute therapy, a 1-month maintenance period, and then a 6-month follow-up period. The study included 246 patients who were randomized to three groups: FPANS 200 micrograms twice a day through the entire 8-month period, FPANS 200 micrograms twice a day during acute therapy and then once a day during the last two periods, or placebo during first two periods and then FPANS 200 micrograms twice a day during the follow-up period.
Study outcomes of interest included change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, symptom intensity, and polyposis grade.
During both the acute and maintenance periods, FPANS 200 micrograms twice a day was superior to placebo on all endpoints.
During the maintenance period, the twice a day frequency of FPANS was more effective than the once a day frequency in terms of clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell, and percentage of nights with no disturbance. By contrast, during the 6-month follow-up period, the two FPANS frequencies provided comparable outcomes.
No new or unexpected adverse outcomes were seen in any of the groups, the report indicates.
"FPANS 200 micrograms/twice daily was effective and well tolerated in the acute treatment of nasal polyposis where it reduced significant the symptoms and polyp size," Dr. Jankowski's team concludes. "Once the symptoms of the disease were controlled, reduction of the FPANS dose to 200 micrograms/daily allowed us to maintain long-term efficacy with a good safety profile."
Allergy. 2009;64:944-950.
Reuters Health Information 2009. © 2009 Reuters Ltd.
July 17, 2009 — Fluticasone propionate nasal spray (FPANS) at 200 micrograms twice a day is an effective acute treatment for nasal polyposis, new research shows. At 200 micrograms once a day, it is useful for long-term control.
Nasal polyposis is due to chronic inflammation of the mucosa lining of the nasal and paranasal sinus. The diagnosis is characterized the presence of polyps on endoscopy and at least two of the following symptoms: nasal blockage, facial pain, rhinorrhea, or hyposmia.
The optimal treatment of nasal polyposis has been the subject of debate for many decades, lead author Dr. Roger Jankowski, from Hopital Central de Nancy, France, and colleagues explain. In a 2007 update, the European Position Paper on Nasal Polyposis recommended topical steroid therapy as first-line treatment, based on findings from several randomized controlled trials of fluticasone and other steroids.
Despite this recommendation, there has been limited data regarding the long-term efficacy and tolerability of steroid therapy for nasal polyposis, according to the report in the June issue of Allergy.
The present study tested three FPANS treatment periods: 1 month of acute therapy, a 1-month maintenance period, and then a 6-month follow-up period. The study included 246 patients who were randomized to three groups: FPANS 200 micrograms twice a day through the entire 8-month period, FPANS 200 micrograms twice a day during acute therapy and then once a day during the last two periods, or placebo during first two periods and then FPANS 200 micrograms twice a day during the follow-up period.
Study outcomes of interest included change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, symptom intensity, and polyposis grade.
During both the acute and maintenance periods, FPANS 200 micrograms twice a day was superior to placebo on all endpoints.
During the maintenance period, the twice a day frequency of FPANS was more effective than the once a day frequency in terms of clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell, and percentage of nights with no disturbance. By contrast, during the 6-month follow-up period, the two FPANS frequencies provided comparable outcomes.
No new or unexpected adverse outcomes were seen in any of the groups, the report indicates.
"FPANS 200 micrograms/twice daily was effective and well tolerated in the acute treatment of nasal polyposis where it reduced significant the symptoms and polyp size," Dr. Jankowski's team concludes. "Once the symptoms of the disease were controlled, reduction of the FPANS dose to 200 micrograms/daily allowed us to maintain long-term efficacy with a good safety profile."
Allergy. 2009;64:944-950.
Reuters Health Information 2009. © 2009 Reuters Ltd.
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