The following is a summary of “Topical corticosteroids for chronic rhinosinusitis with nasal polyposis: GRADE systematic review and network meta-analysis,” published in the December, 2022 issue of Allergy and Clinical Immunology by Bognanni, et al.


The illness burden of chronic rhinosinusitis with nasal polyposis (CRSwNP) is substantial. When treating CRSwNP, it was uncertain how intranasal corticosteroids (INCS) should be administered and at what dosage. For a study, researchers meticulously analyzed the data pertaining to INCS for CRSwNP.

They looked for randomized controlled trials that contrasted INCS administered using any delivery mechanism to placebo or other forms of INCS administration in studies archived in Medline, Embase, and Central from the time the databases were created until September 1, 2021. Pairs of reviewers independently and twice judged the risk of bias using the CLARITY revision of the Cochrane Risk of Bias version 1 instrument. Using random effects network meta-analyses, they compiled the data supporting each conclusion. Using the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) method, they evaluated the evidence critically.

The study included 61 randomized controlled trials (7,176 participants, 8 interventions). When compared to placebo, the INCS rinse (mean difference [MD] −6.83, 95% CI −11.94 to −1.71) and exhalation delivery system (EDS) (MD −7.86, 95% CI −14.64 to −1.08) could enhance the quality of life associated with sinusitis (both low certainty evidence). When receiving INCS through stent/dressing (MD −0.31, 95% CI −0.54 to −0.08), spray (MD −0.51, 95% CI −0.61 to −0.41), and EDS (MD −0.35, 95% CI −0.51 to −0.18) against placebo, nasal obstruction symptoms are probably relieved. Between treatments, they didn’t find any significant variations in the negative impacts (moderate certainty for INCS spray, very low to low certainty for others).

Multiple INCS administration methods were effective therapy choices for CRSwNP, improving crucial patient results. Stent, spray, and EDS delivery of INCS appeared to be advantageous over the broadest range of taken-into-account outcomes.

Reference: jacionline.org/article/S0091-6749(22)01050-8/fulltext