Efficacy and safety of intranasal medications for allergic rhinitis: Network meta-analysis.

Data de publicação: 01/01/2025 Data Ahead of Print: 16/11/2024

Autores da FMUP

Rafael José Monteiro Da Silva Vieira

Autor
João De Almeida Lopes Da Fonseca

Autor

Participantes de fora da FMUP

Sousa-Pinto B
Bognanni A
Gil-Mata S
Ferreira-da-Silva R
Ferreira A
Cardoso-Fernandes A
Ferreira-Cardoso H
Marques-Cruz M
Duarte VH
Castro-Teles J
Campos-Lopes M
Teixeira-Ferreira A
Lourenço-Silva N
Chérrez-Ojeda I
Bedbrook A
Klimek L
Nuñez JJY
Zuberbier T
Schünemann HJ
Bousquet J
ARIA 2024 guideline panel

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: Intranasal antihistamines (INAH), corticosteroids (INCS), and their fixed combinations (INAH+INCS) are one of the cornerstones of the treatment of allergic rhinitis (AR). We performed a systematic review and network-meta-analysis comparing the efficacy and safety of INAH, INCS, and INAH+INCS in patients with AR. METHODS: We searched four electronic bibliographic databases and three clinical trial databases for randomised controlled trials assessing the use of INAH, INCS, and INAH+INCS in adults with seasonal or perennial AR. We performed a network meta-analysis on the Total Nasal Symptom Score, Total Ocular Symptom Score, Rhinoconjunctivitis Quality-of-Life Questionnaire, development of adverse events, and withdrawals due to adverse events. Certainty of evidence was assessed using GRADE-NMA. RESULTS: We included 167 primary studies, most of which assessed patients with seasonal AR. Among individual medications, azelastine-fluticasone, and fluticasone furoate were the most frequently highest-ranked interventions for efficacy outcomes, being regularly associated with clinically meaningful larger improvements when compared to other active treatments. Considering drug classes, INAH+INCS were the highest-ranked interventions for all outcomes in which they were assessed, followed in most cases by INCS. In 105 out of 184 comparisons in seasonal AR, and 28 out of 97 comparisons in perennial AR, certainty of evidence was considered "high" or "moderate". CONCLUSION: Intranasal medications for AR display clinically relevant differences in their efficacy, but all show a good safety profile. To our knowledge, this is the first network meta-analysis comparing INAH, INCS, and INAH+INCS in AR, providing relevant evidence for guideline developers and practising physicians on the most efficacious treatments.

Dados da publicação

ISSN/ISSNe:: 0105-4538, 1398-9995
Tipo:: Article
Páginas:: 94-105
DOI:: 10.1111/all.16384
Link para outro recurso:: www.scopus.com

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Filiações

Sousa-Pinto B:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Vieira RJ:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Bognanni A:: Clinical Epidemiology and Research Center (CERC), Humanitas University and Humanitas Research Hospital, Milan, Italy

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
Gil-Mata S:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Ferreira-da-Silva R:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Ferreira A:: CINTESIS@RISE-Health Research Network, MEDCIDS, 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
Cardoso-Fernandes A:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Ferreira-Cardoso H:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Marques-Cruz M:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Duarte VH:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Castro-Teles J:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Campos-Lopes M:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Teixeira-Ferreira A:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Lourenço-Silva N:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Chérrez-Ojeda I:: Universidad Espíritu Santo, Samborondón, Ecuador

Respiralab Research Group, Guayaquil, Guayas, Ecuador
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
Nuñez JJY:: School of Medicine, Universidad de los Andes, Bogotá, Colombia

Fundación Santa Fe de Bogotá Hospital University, Bogotá, Colombia
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 ITMP, Immunology and Allergology, Berlin, Germany
Fonseca JA:: Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE-Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Schünemann HJ:: Clinical Epidemiology and Research Center (CERC), Humanitas University and Humanitas Research Hospital, Milan, Italy

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
Bousquet J:: 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 ITMP, Immunology and Allergology, Berlin, Germany

ARIA, Montpellier, France

Keywords

allergic rhinitis; antihistamines; corticosteroids; intranasal medications; network meta-analysis; systematic review