A Scholarly Review of the Safety and Efficacy of Intranasal Corticosteroids Preparations in the Treatment of Chronic Rhinosinusitis

Abstract

Objective: The purpose of this scholarly review is to present an update of the efficacy, safety, and distribution of intranasal corticosteroids (INCS) in the context of treatment for chronic rhinosinusitis (CRS). Materials and Methods: A literature review from 1999 to 2020 of MEDLINE, PubMed, and EMBASE databases was performed, using a comprehensive search strategy. Studies reporting on efficacy, safety, and distribution of all INCS formulations, both Food and Drug Administration (FDA) and non-FDA approved, were reviewed. Results and Conclusions: High-level evidence publications and position papers support the role of INCS in medical treatment for CRS. Significant improvement in disease-specific and general quality of life measures is observed with all formulations of INCS. Overall, the use of both FDA and published non-FDA INCS appears to be safe. Several novel distribution devices might improve penetration to specific areas within the sinuses.

Effect of an Intranasal Corticosteroid on Quality of Life and Local Microbiome in Young Children With Chronic Rhinosinusitis

“…Nevertheless, both the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis and EPOS guidelines stand by the recommendation of INCs as a part of first-line treatment in CRS, due to their well-documented safety profile and antiinflammatory effects. 1,2,4,5 In our 12-week intervention, the INC group showed a significant improvement in symptoms compared with the control group. While not surprising, the finding can be considered novel and important in light of the lack of RCTs of INCs in the pediatric population.…”

“…However, almost all clinical trials investigating INCs in CRS have been performed with an adult population, with very little clinical data in children available to date. Nevertheless, both the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis and EPOS guidelines stand by the recommendation of INCs as a part of first-line treatment in CRS, due to their well-documented safety profile and anti-inflammatory effects …”

“…As such, intranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinusitis in both adults and children, despite the lack of evidence regarding their efficacy in the pediatric population. Such a recommendation is typically asserted because of the exceptional anti-inflammatory properties of INCs and their well-documented safety profile, but to this point, it is not supported by data from randomized clinical trials (RCTs) …”

“…Such a recommendation is typically asserted because of the exceptional anti-inflammatory properties of INCs and their well-documented safety profile, but to this point, it is not supported by data from randomized clinical trials (RCTs). [3][4][5] Although the cause of chronic rhinosinusitis is not fully understood, a growing body of research suggests that the breakdown of the sinonasal microbiome may play a significant role in its development and as such could be a potential target for future treatment strategies. [6][7][8][9][10] Similarly, innate lymphoid cells (ILCs) are reported to be actively involved in several inflammatory diseases, but their specific contributions to the cause of CRS remain to be fully understood.…”

Importance of Spray–Wall Interaction and Post-Deposition Liquid Motion in the Transport and Delivery of Pharmaceutical Nasal Sprays

“…Nasal spray pumps are commonly used to deliver locally acting formulations to treat diseases and disorders such as allergic rhinitis, sinusitis, nasal polyposis and migraines [ 1 , 2 , 3 , 4 ]. Nasal spray pumps are popular due to their simplicity and ease of use, requiring no additional power or gas source [ 1 , 5 , 6 , 7 , 8 , 9 ].…”