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Type: Journal article
Title: Short course of systemic corticosteroids in sinonasal polyposis: A double-blind, randomized, placebo-controlled trial with evaluation of outcome measures
Author: Hissaria, P.
Smith, W.
Wormald, P.
Taylor, J.
Vadas, M.
Gillis, D.
Kette, F.
Citation: Journal of Allergy and Clinical Immunology, 2006; 118(1):128-133
Publisher: Mosby Inc
Issue Date: 2006
ISSN: 0091-6749
Statement of
Pravin Hissaria, William Smith, Peter J. Wormald, James Taylor, Mathew Vadas, David Gillis and Frank Kette
Abstract: Background: Topical and systemic corticosteroids are the first choice in medical treatments for sinonasal polyposis, but surprisingly, there is no high-level evidence for the efficacy of oral corticosteroids. Objective: The aim of this study was to establish the efficacy of a short course of oral prednisolone in ameliorating the symptoms of sinonasal polyposis, as well as reducing mucosal inflammation assessed by means of nasendoscopy and magnetic resonance imaging (MRI). A secondary aim was to evaluate the relationship between outcome measures. Methods: Subjects with symptomatic endoscopically diagnosed sinonasal polyposis received 50 mg of prednisolone daily for 14 days or placebo. Outcome was quantified by using the modified 31-item Rhinosinusitis Outcome Measure questionnaire, physician's assessment, nasendoscopy with photography, and MRI. Results: There were 20 subjects in each treatment group. Only the prednisolone-treated group showed significant improvement in nasal symptoms (P < .001). The Rhinosinusitis Outcome Measure score improved in both groups, but the prednisolone-treated group had significantly greater improvement than the placebo group (P < .001). Objectively, there was significant reduction in polyp size, as noted with nasendoscopy (P < .001) and MRI (P < .001), only in the prednisolone-treated group. The outcome measures correlated with each other; the highest level of correlation was between the objective measures of nasendoscopy and MRI (R2 = 0.76, P < .001). There were no significant adverse events. Conclusion: This trial clearly establishes clinically significant improvement in the symptoms and pathology of sinonasal polyposis with a short course of systemic corticosteroids. MRI scanning and quantitative nasendoscopic photography are objective and valid tools for assessing the outcome of treatment in this condition. Clinical implications: A 14-day course of 50 mg of prednisolone is safe and effective therapy for symptomatic nasal polyposis.
Keywords: Nasal polyps; corticosteroids; medical treatment; 31-item rhinosinusitis outcome measure; endoscopy; magnetic resonance imaging; outcome; randomized; double blind; placebo controlled
RMID: 0020061003
DOI: 10.1016/j.jaci.2006.03.012
Appears in Collections:Medicine publications

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