Effects of decongestant addition to intranasal corticosteroid for chronic rhinitis: a systematic review and meta-analysis.

BACKGROUND: Intranasal corticosteroid (INCS) is the most efficacious medicine for treating chronic rhinitis. A decongestant and INCS combination (INCS-D) is considered for nasal congestion that is not improved by INCS. This study aimed to investigate the effects of INCS-D on chronic rhinitis.

METHODS: Literature searches were performed using MEDLINE and EMBASE. Randomized controlled trials studying the effects of INCS-D vs INCS alone for treating chronic rhinitis were included. Data were pooled for meta-analysis. Outcomes were nasal symptoms, disease-specific quality of life, objective tests for nasal patency, and adverse events.

RESULTS: Six studies (1071 patients) met the inclusion criteria. There were no differences between INCS-D and INCS on total nasal symptom scores (standardized mean difference [SMD] -0.85; 95% confidence interval [CI], -2.09 to 0.40; p = 0.18), nasal congestion scores (SMD -0.13; 95% CI, -0.46 to 0.20; p = 0.43), and the Rhinoconjunctivitis Quality of Life Questionnaire score (SMD -0.12; 95% CI, -0.66 to 0.42; p = 0.66). After 1 week, there were no differences on objective tests for nasal patency (acoustic rhinometry: SMD 0.04; 95% CI, -0.68 to 0.76, p = 0.91; and peak nasal inspiratory flow: SMD 0.08; 95% CI, -0.16 to 0.32; p = 0.52). Adverse events were not different between INCS-D and INCS (risk ratio 1.09; 95% CI, 0.73 to 1.62).

CONCLUSION: Meta-analyses did not show benefits of topical decongestants addition to INCS. Adverse events of INCS-D were comparable with INCS.