Treatment outcomes and predictors for systemic steroids in nasal polyposis

Abstract

Conclusion: Systemic steroids improve nasal symptoms such as sneezing, purulent rhinorrhea, and nasal obstruction in patients with nasal polyposis, regardless of measurable response to systemic steroid. A history of allergic rhinitis is an independent prognostic factor for favorable response of nasal polyposis to systemic steroid. Overexpression of glucocorticoid receptor β is associated with glucocorticoid resistance. Objectives: This study was conducted to evaluate treatment outcomes and clinically useful predictive factors for systemic steroids in nasal polyposis. Methods: The study involved 47 consecutive patients diagnosed with nasal polyposis from December 2008 to May 2010. Twenty milligrams of prednisolone were administered daily for 14 days. The following parameters were analyzed: subjective nasal symptoms, history of allergic rhinitis and asthma, SNOT-20 score, olfactory function test, bronchial hyperreactivity, blood eosionophil count, atopy, Lund-Mackay score, tissue eosinophil infiltration ratio, and expression of glucocorticoid receptor α and β in the nasal polyp epithelium. Results: In all, 62% of the patients were responders, i.e. had a decreased polyp size >25% after treatment. SNOT-20 score tended to decrease for all patients but significantly only for the responder group (p < 0.01). Eighteen of the responders had a medical history of allergic rhinitis, but only five of the nonresponders did (p = 0.026, Odds ratio = 4.26). Responder group polyps showed significantly less immunoreactivity of glucocorticoid receptor β than polyps from the nonresponder group.