Comparison of efficacy of fluticasone propionate versus clarithromycin for postoperative treatment of different phenotypic chronic rhinosinusitis: a randomized controlled trial

Abstract

Background: Chronic rhinosinusitis (CRS) can be divided to CRS without nasal polyps (CRSsNP) and eosinophilic and non-eosinophilic CRS with nasal polyps (CRSwNP). There is little evidence on the efficacy of glucocorticoids and macrolides in different phenotypic patients. The aim of this study was to compare the benefit of glucocorticoids and macrolides following endoscopic sinus surgery (ESS) in different phenotypic CRS. Methods:This study was a prospective single-blind comparative effectiveness trial. A total of 187 Chinese patients with CRS were stratified to CRSsNP and eosinophilic and non-eosinophilic CRSwNP group and then randomized to receive fluticasone propionate nasal spray at 200 μg or clarithromycin tablet at 250 mg once daily for 3 months after ESS. Oral prednisone was given as a rescue therapy after the stop of study medication. Patients were assessed before ESS and 1, 3, 6 and 12 months after dosing. Symptom severity was scored by patients using visual analog scale method and endoscopic findings were scored by the senior physician blinded to treatment according to European Position Paper on Rhinosinusitis and Nasal polyps 2012. Results:The total and individual symptom scores, and total and individual endoscopic domain scores were reduced significantly after ESS in both medication groups, whereas no significant difference was observed for two medications at most follow-up visits in each subtype of CRS. No difference in the frequency of subjects with rescue therapy or refractory CRS was found between two medication groups either. Conclusions:We could not show significant difference of effect between fluticasone propionate and clarithromycin in the postoperative treatment for CRSsNP and eosinophilic and non-eosinophilic CRSwNP patients.

Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis

“…In addition to improvements in the above outcomes, RWE studies reported that non-biologics improved SNOT-22 scores, Lund-Kennedy CT and endoscopic scores, total symptom scores by VAS, and nasal polyp scores (Supplementary Tables 5, 7 , 9, 11, 13, and 14). Four RCTs [77][78][79][80] and 4 RWE studies [81][82][83][84] reported on non-biologics (corticosteroids and ESS) for patients with eCRSwNP. All eight studies demonstrated improvement in clinical outcomes.…”

Long-term antibiotics for Chronic Rhinosinusitis: changing views

“…The authors concluded that CRSsNP and longer duration of treatment (24 weeks) were predictors of success (7) . The other factors were not helpful, particularly in the postoperative period, where there does not seem to be an additive effect of macrolides over nasal corticosteroids alone (7,8) . Recently it was proposed to systematically use eosinophils (as a marker of Th2 disease) on top of phenotyping based on the presence of nasal polyps, to differentiate treatments in CRS (9) .…”

Self-Reported Taste and Smell Disorders in Patients with COVID-19: Distinct Features in China

“…We found that 82.1% (110/134) of patients with loss of sense of smell and 95.5% (231/242) of patients with loss of taste recovered in one month after discharge. The symptomatic duration days showed no difference between the patients with loss of smell and taste (8 [6-13.25] vs 7 [5][6][7][8][9][10][11][12][13][14] days, P = 0.52) (Fig 1, C). Most of them recovered in 14 days after onset of symptom (Fig 1, D).…”

“…More COVID-19 cases with severe illness were found in the severe loss of taste group than in the moderate loss of taste group (26.9% vs 12.7%, P = 0.03). The symptom duration of loss of taste was signi cantly longer in moderate and severe taste dysfunction group as compared to the mild taste dysfunction group (8 days [6-13.25], 10 days [5][6][7][8][9][10][11][12][13][14][15] vs 5 days [3.5-8], P < 0.01) (Fig 2). In addition, serum levels of interleukin-6 (IL-6) and lactate dehydrogenase (LDH) were signi cantly increased in patients with severe compared to mild and moderate loss of taste group (Table 2).…”

“…Since the taste disorder was the most common upper respiratory tract symptoms and showed positive correlation to the symptom of loss of smell, we subsequently compared the differences among the COVID-19 patients with different severity of loss of taste ( Table 2) and loss of smell (Table 3). First, we divided 242 COVID-19 cases with loss of taste into mild (score, 1-3; 19.0%), moderate (score, 4-7; 48.8%) and severe (score, 8-10; 32.2%) group by symptom scores, similar to the visual analogue scale system of nasal symptoms (10). More COVID-19 cases with severe illness were found in the severe loss of taste group than in the moderate loss of taste group (26.9% vs 12.7%, P = 0.03).…”