Nonmedicated control substances Show Limited Efficacy in Chronic Sinusitis: Study

CRS is a clinically challenging disease; as in asthmatic patients, symptoms lack good correlation with objective measurements because of the lack of a gold standard. It is usually treated with nasal corticosteroids, over-the-counter medications or non-medicated substances like saline nasal irrigation/nasal sprays. However, the effect of nonmedicated control substances in chronic rhinosinusitis remains unclear. Therefore, Dr Lisa Caulley and team conducted a study to assess the association of nonmedicated control substances in randomized clinical trials with disease outcomes in patients diagnosed with chronic rhinosinusitis.

It was a single-arm systematic review and meta-analysis. Researchers evaluated the databases of the Cochrane Library of Systematic Reviews, Ovid MEDLINE, Embase, PubMed, and ClinicalTrials.gov for randomized clinical trials with a preintervention and postintervention design for chronic rhinosinusitis that were published between 1946 and January 23, 2019. Paired reviewers independently extracted data. The major outcomes assessed were the association of nonmedicated control substances with 22-item Sinonasal Outcome Test (SNOT-22) scores or nasal symptom scores when SNOT-22 was not available. Researchers screened a total of 2305 abstracts and included 38 articles in the meta-analysis.

Key findings of the study were:

• Upon analysis, they found that the topical nonmedicated control substances were associated with a significant reduction in SNOT-22 scores (mean difference [MD], −8.81).

• They conducted a subgroup analysis of topical therapies, limited to saline irrigation and nasal spray diluents and found that topical diluents were associated with a greater reduction in SNOT-22 scores (MD, −11.45) compared with saline irrigation (MD, −13.60).

• They also found that nonmedicated control substances were associated with a significant reduction in nasal obstruction scores (standardized MD [SMD], −0.42).

• However, they found no significant changes in rhinorrhea scores (SMD, −0.34), postnasal drip scores (SMD, −0.96), facial pain scores (SMD, −0.57), or loss of smell scores (SMD, −0.18).

The authors concluded, " This systematic review and meta-analysis of the use of nonmedicated control substances in randomized clinical trials of chronic rhinosinusitis outcomes suggest that the use of nonmedicated control substances is associated with limited improvements in SNOT-22 and nasal obstruction scores."

They further added, "These findings highlight potential areas of future research directions and the importance of randomized clinical trials to accurately estimate the treatment effect."

For further information:

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2772878