Effect of Topical Nasal Steroids on Nasal Polyp Size: A Meta-Analysis

Abstract

RATIONALE: Topical nasal steroids are mainstay therapy for chronic rhinosinusitis with nasal polyps. The purpose of this meta-analysis is to review the literature and pool data from clinical trials to assess the effect of topical nasal steroids on polyp size. METHODS: A Medline, Pubmed, and Cochrane database search was conducted using the key search terms: topical steroids and nasal polyps, mometasone and nasal polyps, budesonide and nasal polyps, and fluticasone and nasal polyps. All abstracts were reviewed and 30 potential clinical trials were evaluated. Included studies were randomized, placebo-controlled clinical trials, reported nasal polyp size as a primary measure, and topical nasal steroid was used alone (no systemic steroids). The last date of search was August 14, 2008. For analysis, the adjusted mean change in nasal polyp size score and the standard error was extracted from the results of each study. Data was analyzed using the RevMan 5 program with mean difference effect measure. RESULTS: Four randomized, placebo-controlled trials were included in this analysis. Two trials had data from multiple doses of nasal steroids administered versus placebo. Subjects in the included studies (n = 885) received budesonide nasal spray, mometasone furoate nasal spray, or placebo for 4 months (1), 8 weeks (2), or 14 days (1). Subjects demonstrated significant overall improvement in nasal polyp size (mean difference [95% confidence interval]: -0.57 [-0.69, -0.45] when compared to placebo. CONCLUSION: Topical nasal steroids demonstrate clear improvement in polyp size over placebo. In those studies measuring multiple steroid doses there was a trend towards greater effect from higher doses of steroids.