Clinical Health Updates

Oral steroids effective for nasal polyps

Clinical Question:
Are oral steroids effective in the management of nasal polyps?

Bottom Line:
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.

Reference:
Hissaria P, Smith W, Wormald PJ, et al. Short course of systemic corticosteroids in sinonasal polyposis: A double-blind, randomized, placebo-controlled trial with evaluation of outcome measures. J Allergy Clin Immunol 2006;118:128-133.

Study Design:
Randomized controlled trial (double-blinded)

Synopsis:
These investigators identified 41 adults, aged 18 years to 64 years, with symptomatic polyp disease diagnosed by nasendoscopy. Patients randomly received (concealed allocation assignment) prednisolone (50 mg) or matched placebo once daily for 14 days. Individuals assessing outcomes remained blinded to treatment group assignment. Follow-up occurred for more than 97% of patients for 14 days. Subscores from a cluster of 6 nasal symptoms (congestion, rhinorrhea, sneezing, hyposmia, postnasal discharge, and thick nasal debris) derived from a 31-item questionnaire assessing rhinosinusitis outcomes were reported at baseline and after 2 weeks of therapy. Using intention-to-treat analysis, a clinically significant (> 20%) improvement in scores occurred in 95% of prednisolone-treated patients, compared with 37% in the placebo group (number needed to treat = 2; 95% CI, 1-3). Polyp size as assessed by nasendoscopy was also significantly reduced. Insomnia occurred significantly more often in the prednisolone group, but other side effects were infrequent and not different between the treatment groups.