Review: Patient preferences for Intranasal Corticosteroids on account of Sensory Attributes

Intranasal corticosteroids are the pillar treatment for allergic rhinitis, a broad disease that affects over 500 million people around the world (1,2). Allergic rhinitis is viewed as a major public health problem due to the burden of illness, combined with increasing expanding pervasiveness and economic impact (1).

Among the multiple pharmacological interventions that exist for the treatment, numerous studies have shown the viability of intranasal corticosteroids in treating allergic rhinitis (2).

The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines recommended intranasal corticosteroids as the first-line treatment for allergic rhinitis (3). The standard guideline for the management of allergic rhinitis in India prepared by the Ministry of Health and Family Welfare recommended the use of second generations of intranasal corticosteroids, Fluticasone furoate, as a nasal spray in outpatient treatment.

By and large, intranasal corticosteroids ease nasal congestion and itching, rhinorrhea, and sneezing, and in certain studies, they noted that they totally forestalled late-stage manifestations (4). They are known to be more viable than the joined utilization of an antihistamine and leukotriene (LT) antagonist in the treatment of seasonal allergic rhinitis (5).

Furthermore, customary utilization of intranasal corticosteroids is likewise known to be related to increases in peak nasal inspiratory flow and improved quality of life. Simultaneously, there are subtle nuances for a physician that should be considered when selecting a medication to prescribe. (2)

Sensory Attributes and Adherence!

Patient adherence is fundamental in the treatment of any infection on the grounds that better health and ideal results are reliant upon patients receiving their prescriptions properly. Adherence is imperative in long haul executives of allergic rhinitis with intranasal corticosteroids, and the absence of adherence can be a hindrance to viable treatment. (6)

Intranasal corticosteroids have a few sensory traits that add to patients' acknowledgment of the medication and ability to stick to treatment. These attributes are qualities of the medication, including the actual device and spray (eg, scent, taste, irritation, or leakage). Sensory attributes of intranasal corticosteroids products, by all accounts, seem to be possibly significant contemplations while assessing elective intranasal corticosteroids items for drug treatment choice or formulary arrangement. (6)

A cross-sectional review done by Mahadevia et.al evaluated patient inclinations for intranasal corticosteroid sensory attributes and how much credits impact patients' readiness to stick to treatment. The paper noticed that aftertaste or taste is the most important sensory attribute. They moreover revealed that patients have inclinations about sensory attributes of intranasal corticosteroids and that these preferences affect willingness. (7)

It has been as well witnessed by Shah et.al in their cross-sectional study to evaluate patients' willingness to pay (WTP) for intranasal corticosteroid products with differing sensory attribute profiles. Over 90% of the patients demonstrated significant willingness to pay to avoid certain sensory attributes of intranasal corticosteroids (8).

Patients with allergic rhinitis are willing to pay higher monthly copayments for products with mild intensity levels of each sensory attribute than those with higher intensity levels; that is, patients were willing to pay from US dollar 6 (spray with a wet feel) to US dollar 20 (for no aftertaste) to avoid the more severe intensity levels of a given attribute. (8)

Patient Preferences among available Intranasal Corticosteroids

• A randomized study analyzed product attributes that influence patient preference for intranasal corticosteroid therapy in allergic rhinitis. The aim of the study was to look at the item sensory attributes and patient preferences of fluticasone furoate (FF) and fluticasone propionate (FP) nasal sprays in patients with symptomatic perennial and/or seasonal allergic rhinitis. The patient rated sensory attributes after receiving a single dose of either Fluticasone furoate or Fluticasone propionate. Patient ratings favored Fluticasone furoate over Fluticasone propionate with respect to odor, taste, dripping down the throat, and nose run off. (9)
• Another cross-over patient preferences study evaluated patient preferences for fluticasone furoate nasal spray (FFNS) or mometasone furoate nasal spray (MFNS) based on their sensory attributes after administration in patients with allergic rhinitis. Patients preferred FFNS instead of MFNS based on the individual attributes of "less run down the throat," "less run out of the nose," "more soothing," and "less irritating." The paper further noted that a more prominent preference might improve patient adherence and in this way improve symptom management of patients' allergic rhinitis. (10)
• Yonezaki et.al carried out a randomized prospective study on 40 patients with seasonal allergic rhinitis who were administered with both fluticasone furoate nasal spray (FFNS) and mometasone furoate nasal spray (MFNS) for two weeks. FFNS was significantly preferred over MFNS on an account of less bitter taste, medication running down their throat, and medication running out of their nose with FFNS. They even noted that MFNS was more frequently reported to induce nasal irritation, sneezing, and rhinorrhea compared to FFNS. (11)

The above three findings all suggest fluticasone furoate nasal spray that may contribute to enhanced allergic rhinitis treatment outcomes due to improved treatment adherence.

Key Words

• Intranasal corticosteroids are an important treatment for allergic rhinitis, and perceived product sensory attributes contribute to patient preference.
• Choosing intranasal corticosteroids products that better fit patients' intranasal sensory attribute preferences may increase adherence.
• The aftertaste, throat rundown, and nose runout seemed to have a higher willingness to pay to avoid both moderate and severe intensity levels among patients treated with intranasal corticosteroids.
• The smell, taste, and feel of spray had a higher willingness to pay to avoid only the severe intensity level. This information may inform prescribing and formulary decisions.
• Prescribing should be made in the light of bioavailability, intranasal environment, and factors that impact patient adherence.
• Fluticasone furoate is highly preferred among patients with allergic rhinitis due to several sensory attributes factors.

References:

1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008

2. James Fowler, Brian W. Rotenberg and Leigh J. Sowerby. The subtle nuances of intranasal corticosteroids. 2021. Journal of Otalaryncology- Head and Neck Surgery.

3. Pedro Giavina-Bianchi, Rosana Agondi
Rafael Stelmach Alberto Cukier, Jorge Kalil. Fluticasone furoate nasal spray in the treatment of allergic rhinitis. 2008 Therapeutics and Clinical Risk Management.

4. Amanda J. Trangsrud, Amy L. Whitaker, and Ralph E. Small. Intranasal Corticosteroids for Allergic Rhinitis. Pharmacotherapy 2002

5. Wallace DV et al., Journal of allergy and clinical immunology. 2008 Aug 1;122(2):S1-84.

6. J. Russell May, William K. Dolen. Evaluation of Intranasal Corticosteroid Sensory Attributes and Patient Preference for Fluticasone Furoate for the Treatment of Allergic Rhinitis. 2019. Clinical Therapeutics.

7. Mahadevia, P. J., Shah, S., Leibman, C., Kleinman, L., & O'Dowd, L. Patient preferences for sensory attributes of intranasal corticosteroids and willingness to adhere to prescribed therapy for allergic rhinitis: a conjoint analysis. 2004.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

8. Mahadevia, P., Shah, S., Mannix, S., Brewster-Jordan, J., Kleinman, L., Liebman, C., et.al .Willingness to pay for sensory attributes of intranasal corticosteroids among patients with allergic rhinitis. (2006). Journal of managed care pharmacy

9. Meltzer EO, Stahlman JE, Leflein J, Meltzer S, Lim J, Dalal AA, et.al Preferences of adult patients with allergic rhinitis for the sensory attributes of fluticasone furoate versus fluticasone propionate nasal sprays: a randomized, multicenter, double-blind, single-dose, crossover study. 2008.Clin Ther.

10. Anahi Yanez, Alex Dimitroff,Peter Bremner,Chae-Seo Rhee,Graham Luscombe,Barbara A. Prillaman, et.al. A patient preference study that evaluated fluticasone furoate and mometasone furoate nasal sprays for allergic rhinitis. 2016. Allergy Rhinology

11. Masafumi Yonezaki, Kosuke Akiyama, Masayuki Karaki, Rieko Goto, Rhyuhei Inamoto, Yasushi Samukawa. et.al Preference evaluation and perceived sensory comparison of fluticasone furoate and mometasone furoate intranasal sprays in allergic rhinitis. 2015. Auris Nasus Larynx.