In one study, MFNS patients took 173 days to relapse, compared with 61 days for those who took a placebo (Stjarne P. et al. Arch Otolargyngol Head Neck Surg 2009;135:296-302).
Explore This IssueOctober 2009
Studies have also found that oral steroids, too, can help combat nasal polyps (Hissaria P et al. J Allergy Clin Immunol 2006;118:128-33; Benitez P. Laryngoscope 2006;116:770). But taking systemic corticosteroids should not be done without caution. Careful dosage is essential to limiting side effects, Dr. Cervin said.
In one study (Holmstrom et al. Acta Otolaryngol 2002;122:736-44), the dosage recommendation for prednisolone was 30 mg once a day for seven days, followed by 20 mg once a day for seven days, then 10 mg once a day for seven days-a series that could be repeated three times a year if needed.
A study led by Dr. Bachert (Drugs 2005;65:1537-52) found that a two- to three-week course of methylprednisolone should be recommended, starting at 32 mg once a day and reduced by half every five days, until the dose is cut to 8 mg. That regimen could be given up to four times a year, according to the study.
The American College of Rheumatology has recommended that patients starting long-term glucocorticoid therapy (5 mg a day or more for at least three months) should have bisphosphonate therapy to prevent bone loss, Dr. Cervin noted.
There is a lack of placebo-controlled trials evaluating antibiotics’ effect on polyps. Two uncontrolled studies have shown a reduction of polyp size, but a third showed no effect.
Macrolides have been shown to be more effective in neutrophilic inflammation, but might lack an effect in atopic patients.
Capsaicin has been shown to reduce recurrences, cut down polyp size, and improve rhinitis symptoms, Dr. Cervin said.
Leukotriene antagonists might be an alternative for patients with sensitivity to aspirin, but its effectiveness has not been documented, he said.
Furosemide is a possible alternative for steroid-resistant patients. Two studies have shown an effect compared to a placebo. A furosemide spray prevented relapse of polyposis better than mometasone spray and a placebo in one study (Passali et al. Arch Otolaryngol Head Neck Surg 2003;129:656-59).
According to the European Position Paper on Rhinosinusitis and Nasal Polyps 2007, the highest evidence grades for treatments still went to topical steroids, oral steroids, and nasal douche, which all received grades of A.
Ultimately, Dr. Cervin said, it is important for physicians to assess each patient and tailor the treatment accordingly. I think it’s very important that you characterize your patient, he said. It’s just not nasal polyps, it’s nasal polyps with something-for example, asthma or allergy. A treatment directed toward the associated disease as well will improve patients’ quality of life.