Intranasal antihistamines and corticosteroids in allergic rhinitis: A systematic review and meta-analysis.

Data de publicação: 01/08/2024 Data Ahead of Print: 27/04/2024

Autores da FMUP

João De Almeida Lopes Da Fonseca

Autor

Participantes de fora da FMUP

Sousa-Pinto B
Vieira RJ
Brozek J
Cardoso-Fernandes A
Lourenço-Silva N
Ferreira-da-Silva R
Ferreira A
Gil-Mata S
Bedbrook A
Klimek L
Zuberbier T
Schünemann HJ
Bousquet J

Unidades de investigação

Laboratório Associado RISE- Rede de Investigação em Saúde

Investigador

Fernando Carlos De Landér Schmitt
Medicina da Comunidade, Informação e Decisão em Saúde
RISE-Health

Investigador

Fernando Carlos De Landér Schmitt

Abstract

BACKGROUND: There is insufficient systematized evidence on the effectiveness of individual intranasal medications in allergic rhinitis (AR). OBJECTIVES: We sought to perform a systematic review to compare the efficacy of individual intranasal corticosteroids and antihistamines against placebo in improving the nasal and ocular symptoms and the rhinoconjunctivitis-related quality of life of patients with perennial or seasonal AR. METHODS: The investigators searched 4 electronic bibliographic databases and 3 clinical trials databases for randomized controlled trials (1) assessing adult patients with seasonal or perennial AR and (2) comparing the use of intranasal corticosteroids or antihistamines versus placebo. Assessed outcomes included the Total Nasal Symptom Score, the Total Ocular Symptom Score, and the Rhinoconjunctivitis Quality-of-Life Questionnaire. The investigators performed random-effects meta-analyses of mean differences for each medication and outcome. The investigators assessed evidence certainty using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. RESULTS: This review included 151 primary studies, most of which assessed patients with seasonal AR and displayed unclear or high risk of bias. Both in perennial and seasonal AR, most assessed treatments were more effective than placebo. In seasonal AR, azelastine-fluticasone, fluticasone furoate, and fluticasone propionate were the medications with the highest probability of resulting in moderate or large improvements in the Total Nasal Symptom Score and Rhinoconjunctivitis Quality-of-Life Questionnaire. Azelastine-fluticasone displayed the highest probability of resulting in moderate or large improvements of Total Ocular Symptom Score. Overall, evidence certainty was considered "high" in 6 of 46 analyses, "moderate" in 23 of 46 analyses, and "low"/"very low" in 17 of 46 analyses. CONCLUSIONS: Most intranasal medications are effective in improving rhinitis symptoms and quality of life. However, there are relevant differences in the associated evidence certainty.

Dados da publicação

ISSN/ISSNe:: 1097-6825, 0091-6749
Tipo:: Article
Páginas:: 340-354
DOI:: 10.1016/j.jaci.2024.04.016
Link para outro recurso:: www.scopus.com

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Métricas

Filiações

Sousa-Pinto B:: CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal

MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
Vieira RJ:: CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal

MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
Brozek J:: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Cardoso-Fernandes A:: CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal

MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
Lourenço-Silva N:: CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal

MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
Ferreira-da-Silva R:: CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal

MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
Ferreira A:: MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal

Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
Gil-Mata S:: CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal

MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
Bedbrook A:: MASK-air SAS, Montpellier, France
Klimek L:: Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany

Center for Rhinology and Allergology, Wiesbaden, Germany
Fonseca JA:: CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal

MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
Zuberbier T:: Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology, and Allergology, Berlin, Germany
Schünemann HJ:: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Bousquet J:: ARIA, Montpellier, France

Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology, and Allergology, Berlin, Germany

Keywords

Allergic rhinitis; intranasal antihistamines; intranasal corticosteroids; meta-analysis; systematic review