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 (R(2) = 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.
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Authors | Pravin Hissaria, William Smith, Peter J Wormald, James Taylor, Mathew Vadas, David Gillis, Frank Kette |
Journal | The Journal of allergy and clinical immunology
(J Allergy Clin Immunol)
Vol. 118
Issue 1
Pg. 128-33
(Jul 2006)
ISSN: 0091-6749 [Print] United States |
PMID | 16815148
(Publication Type: Journal Article, Randomized Controlled Trial)
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Chemical References |
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Topics |
- Adult
- Aged
- Double-Blind Method
- Female
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Nasal Polyps
(drug therapy, pathology)
- Outcome Assessment, Health Care
- Prednisolone
(adverse effects, therapeutic use)
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