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INAH+INCS fixed combination, particularly azelastine-fluticasone, demonstrates the highest efficacy across nasal symptoms, ocular symptoms, and quality-of-life outcomes in allergic rhinitis, while maintaining a favorable safety profile.
A major systematic review and network meta-analysis of 167 trials has clarified the comparative safety and efficiency of intranasal antihistamines (INAH), intranasal corticosteroids (INCS), and their fixed combination therapy (INAH+INCS) in adults with allergic rhinitis (AR), including both seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR).
Bernardo Sousa-Pinto and other researchers searched 4 electronic bibliographic databases and 3 clinical trial registries to identify relevant randomized controlled trials (RCTs). Key clinical outcomes, including total ocular symptom score (TOSS), total nasal symptom score (TNSS), rhinoconjunctivitis quality-of-life questionnaire (RQLQ), as well as adverse events and withdrawals owing to adverse events were evaluated. A total of 167 primary studies were included, most involving seasonal AR sufferers.
Among individual agents, azelastine-fluticasone and fluticasone furoate most commonly ranked highest for efficacy endpoints. These agents were consistently related to clinically meaningful betterment in ocular symptoms, nasal symptoms, and quality-of-life measures as opposed to other active treatments. When analyzed by therapeutic class, INAH+INCS fixed combinations ranked highest across all evaluated efficacy outcomes, followed in most cases by INCS monotherapy, while INAH monotherapy showed benefit but was less consistently top-ranked.
Regarding the certainty of evidence, 105 of 184 comparisons in SAR and 28 of 97 comparisons in PAR were rated as having high or moderate certainty, indicating stronger confidence in findings for seasonal disease. All intranasal therapies illustrated a favorable safety profile, with low rates of adverse events and treatment discontinuation. No novel safety concerns were identified.
Allergy
Efficacy and safety of intranasal medications for allergic rhinitis: Network meta-analysis
Bernardo Sousa-Pinto et al.
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