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Oral Steroids plus Intranasal Steroids Effective for Chronic Rhinosinusitis and Nasal Polyps

In rhinosinusitis with nasal polyposis, initial treatment with oral steroids followed by intranasal steroids works better than intranasal steroids alone. The advantage lasts about 6 months, according to an Annals of Internal Medicine study.

Researchers studied 60 adult patients who'd been referred because of moderate or large nasal polyps. The patients were randomized to an initial 2-week treatment with either oral prednisolone or placebo; thereafter, all received 8 weeks of fluticasone nasal drops followed by 18 weeks of fluticasone spray. Group-mean measures of polyp sizes dropped significantly more among the prednisolone recipients; in addition, the treatment group also had greater improvement in olfaction scores. By the 28-week mark, however, the differences were no longer statistically significant.

Prednisolone recipients experienced suppressed adrenal function and increased bone turnover, which returned to baseline by 28 weeks.

Editorialists caution against overenthusiasm for the oral regimen, given its potential adverse effects.

LINK(S):

Annals of Internal Medicine article (Free abstract)

Annals of Internal Medicine editorial (Subscription required)

Published in Physician's First Watch March 1, 2011