Are intranasal corticosteroids all equally consistent in managing ocular symptoms of seasonal allergic rhinitis?

ABSTRACT

Background: Nasal and ocular symptoms of allergic rhinitis (AR) are reported by >70% of patients and have a profound impact on quality of life while also incurring substantial healthcare costs. It has been suggested that intranasal corticosteroids (INS), in addition to effectively treating the nasal components of AR, are effective in treating the ocular symptoms.

Objective: This review provides a comprehensive, updated assessment of available data in the public domain to determine the consistency of INS efficacy in treating ocular AR symptoms.

Methods: MEDLINE and EMBASE searches, and research of governmental and regulatory institution sources identified 35 randomised, placebo-controlled trials of INS and seasonal AR (SAR) published between 1990 and May 2009 that specifically contained ocular efficacy as part of the study analyses.

Results: Examination of these studies reveals substantial inconsistency of effect of some INS across, and even within, trials, casting doubt on the suggestion that ocular efficacy is a class effect of INS. Conflicting, inconsistent or even negative effects were observed for most INS examined including mometasone furoate and fluticasone propionate. Only fluticasone furoate nasal spray, in addition to established efficacy in treating nasal symptoms, demonstrated a consistent positive effect on ocular symptoms of SAR compared with placebo in a large number of patients across all of its prospective studies. Moreover, these results were consistent across different allergy seasons, including grass, ragweed, and mountain cedar seasons, and different geographical locations throughout Europe and the USA.

Conclusion: While additional prospective head-to-head clinical trials comparing the efficacy of INS in treating ocular symptoms of AR are needed to fully elucidate the benefits of one INS compared with another, data available to date suggest that not all INS are equally consistent in managing ocular symptoms of SAR. Fluticasone furoate is currently the most consistent.

Keywords: :

• Intranasal corticosteroids
• Nasal
• Ocular
• Seasonal allergic rhinitis (SAR)
• Symptoms

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Declaration of funding

This review article was sponsored by GlaxoSmithKline R&D Ltd, who also reviewed the content of the paper during article preparation.

Declaration of financial/other relationships

P.K. is the recipient of research funding and honoraria for lectures from GSK, Schering and Nycomed and a member of advisory boards for GSK, Schering and Nycomed.

G.S. is the recipient of research funds from GSK, lecture fees from GSK and Schering Plough and is a member of advisory boards for GSK and Schering Plough.

All peer reviewers receive honoraria from CMRO for their review work. Peer Reviewer 1 and Peer Reviewer 2 have disclosed that they have no relevant financial relationships.

Acknowledgements

The authors would like to thank Susan Cheer and Duncan Pennington of Innovex Medical Communications for research and editorial assistance in the development and review of this manuscript. Funding for editorial assistance was supplied by GSK. For access to some studies cited to online sources/websites (regulatory sources), navigation through the website will be required as a specific direct link is not always available.