SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
10/8/04
Fluticasone nasal spray does not influence post-op recurrence of nasal polyps
Summary
Background - Nasal polyps (NP) frequently recur after they are removed surgically. It was hoped that the more extensive nasal/sinus surgery carried out endoscopically (FESS) would prevent NP recurrence after their removal but this has not occurred consistently. A number of clinicians have the impression that continuous use of intranasal steroids such as fluticasone propionate (FP) appears to retard re-growth of NP. But is such prevention a consistent finding?
Findings - Dijkstra et al of the Erasmus Medical Center in Rotterdam, Netherlands carried out a double blind, randomized comparison of the effects of intranasal aqueous FP 400-800 microg b.i.d. vs. placebo nasal spray b.i.d. given for a year to 162 adults who had required FESS for chronic rhinosinusitis or NP (with peri-operative systemic corticosteroids given to all subjects).
A significant reduction of symptoms was seen shortly after the FESS. However, one year later 78 patients had been withdrawn from the trial because of persistent recurrence of symptoms and/or objective signs of disease. The frequency of such recurrences was not significantly different in those treated with intranasal FP vs. placebo. There was no particular efficacy of intranasal FP in those with previous NP prior to FESS.
Reference
Clin Exp Allergy 2004;34:1395-1400
Editor's Comments
The authors of this report concluded that their study showed no beneficial effect of intranasal FP in preventing recurrence of NP or rhinosinusitis after FESS. However, I think that one cannot make such a firm conclusion based on my understanding of this study. The study population was rather heterogeneous in the baseline clinical manifestation. There were also no reliable objective measures of NP size/location post FESS. Several of my colleagues who care for many patients with NP are impressed that intranasal corticosteroids (including FP) do appear to slow the rate of NP re-growth, though not necessarily completely prevent such re-growth.
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