Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis

2019 ◽  
Vol 161 (3) ◽  
pp. 412-418
Author(s):  
Peter M. Debbaneh ◽  
Anna K. Bareiss ◽  
Sarah K. Wise ◽  
Edward D. McCoul
Keyword(s):  
Systematic Review ◽  
Allergic Rhinitis ◽  
Combination Therapy ◽  
Randomized Controlled Trials ◽  
Nasal Spray ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Symptom Scores

Objective Combination therapy with intranasal azelastine and fluticasone propionate is an option for treatment of allergic rhinitis. This systematic review and meta-analysis examines existing literature to determine efficacy in treating allergic rhinitis compared to monotherapy. Data Sources The PubMed, EMBASE, Cochrane, and MEDLINE databases were systematically searched for randomized controlled trials using AzeFlu nasal spray. Review Methods Randomized, controlled trials that reported symptom relief of allergic rhinitis in males and females of all ages were included. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. Results Systematic review identified 8 articles suitable for review. The risk of bias was generally low. All studies exhibited a greater decrease in patient-reported symptom scores in patients treated with combination therapy compared to monotherapy or placebo. Meta-analysis revealed superiority of combination therapy in reducing Total Nasal Symptom Score compared to placebo (mean change from baseline: −2.41; 95% confidence interval [CI], −2.82 to −1.99; P < .001; I 2 = 60%), azelastine (mean change from baseline: −1.40; 95% CI, −1.82 to −0.98; P < .001; I 2 = 0%), and fluticasone (mean change from baseline: −0.74; 95% CI, −1.17 to −0.31; P < .001; I 2 = 12%). Conclusion Current evidence supports both efficacy and superiority of combination intranasal azelastine and fluticasone in reducing patient-reported symptom scores in patients with allergic rhinitis. Combination nasal spray should be considered as second-line therapy in patients with allergic rhinitis that is not controlled with monotherapy.

Efficacy and Safety of Sublingual Immunotherapy for Allergic Rhinitis in Pediatric Patients: A Meta-Analysis of Randomized Controlled Trials

2017 ◽  
Vol 31 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Bohai Feng ◽  
Jueting Wu ◽  
Bobei Chen ◽  
Haijie Xiang ◽  
Ruru Chen ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Randomized Controlled Trials ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Symptom Relief ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Symptom Scores

Background Allergic rhinitis (AR) has become a global health problem that constantly affects a large part of the general population, especially children. Objective Sublingual allergen immunotherapy (SLIT) has been used extensively for pediatric AR, although its efficacy and safety are often questioned. In this meta-analysis of randomized controlled trials (RCT), we evaluated the use of SLIT for pediatric AR. Methods A number of medical literature data bases were searched through January 2016 to identify RCTs that examined the use of SLIT for pediatric AR and that assessed clinical outcomes related to efficacy. Descriptive and quantitative information was abstracted. Standardized mean differences (SMD) were calculated by using fixed- and random-effects models. Subgroup analyses were performed. Heterogeneity was assessed by using the I2 metric. A network meta-analysis was used to estimate SMDs between two SLIT protocols for pediatric seasonal AR. All data were extracted from publications or received from the authors. Results Twenty-six studies were eligible for inclusion in the meta-analysis of rhinitis or rhinoconjunctivitis symptom scores, and 19 studies were eligible for the meta-analysis of medication scores. Descriptive and quantitative data were extracted. SLIT differed significantly from placebo in terms of symptom scores (SMD -0.55 [95% confidence interval {CI}, -0.86 to -0.25]; p = 0.0003, I2 = 90%) and medication scores (SMD -0.67 [95% CI, -0.96 to -0.38J; p < 0.00001, I2 = 83%). Oral pruritus was the adverse effect, which occurred most commonly in children who were receiving SLIT. Network meta-analysis revealed no significant difference between the pre-coseasonal and continuous SLIT protocols for seasonal AR in symptom scores (SMD -6.55 [95% CI, -25.38 to 12.29]; p = 0.496) and medication scores (SMD -8.83 [95% CI, -22.10 to 4.43]; p = 0.192). Conclusions Our meta-analysis results indicated that SLIT provided significant symptom relief and reduced the need for medication in pediatric patients Moreover, the safety of SLIT needs to be confirmed in RCTs with larger samples.

scholarly journals Effectiveness of Exercise Therapy in Treatment of Patients With Patellofemoral Pain Syndrome: Systematic Review and Meta-Analysis

2014 ◽  
Vol 94 (12) ◽  
pp. 1697-1708 ◽  
Author(s):  
Ron Clijsen ◽  
Janine Fuchs ◽  
Jan Taeymans
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Exercise Therapy ◽  
Meta Analysis ◽  
Patellofemoral Pain ◽  
Control Group ◽  
Controlled Trials ◽  
Exercise Interventions ◽  
Randomized Controlled ◽  
Patient Reported

Background and Purpose This systematic review and meta-analysis was accomplished to determine whether exercise therapy is an effective intervention to reduce pain and patient-reported measures of activity limitations and participation restrictions (PRMALP) in patients with patellofemoral pain. Data Sources and Study Selection Randomized controlled trials in English and German languages published in the MEDLINE, Physiotherapy Evidence Database (PEDro), International Clinical Trials Registry Platform, and Cochrane databases were searched. Eligibility was assessed in 2 stages. The methodological quality of the studies was rated using the PEDro scale. Data were pooled using random-effects meta-analysis, allowing for variability among studies. For clinical use, overall estimates were re-expressed in the original visual analog scale scores. Significance was set at 5%. Data Extraction and Data Synthesis Fifteen studies, with a total of 748 participants, were included and pooled for the meta-analysis. Six studies compared the effect of exercise therapy with a control group receiving neither exercise therapy nor another intervention. Four studies compared the effect of exercise therapy versus additive therapy, and 5 studies compared different exercise interventions. In both comparisons, exercise therapy resulted in strong pain reduction and improvement of PRMALP effects. Significant short-term effects (≤12 weeks) of exercise therapy were found for pain and PRMALP, whereas long-term effects (≥26 weeks) were observed for PRMALP only. Limitations and Conclusion The 15 studies included in this analysis were of variable quality. Large-scale, high-quality randomized controlled trials are needed to further the evaluation of the possible effects of different exercise therapy modalities on patellofemoral pain. This meta-analysis presents evidence that exercise therapy has a strong pain-reducing effect and decreases PRMALP in patients with patellofemoral pain. However, the question of which exercise modality yields the strongest reducing effect on pain and PRMALP remains unanswered.

Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 194589242110414
Author(s):  
Kathy Zhang ◽  
Andraia R. Li ◽  
Amar Miglani ◽  
Shaun A. Nguyen ◽  
Rodney J. Schlosser
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Allergic Rhinitis ◽  
Treatment Effect ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Nasal Airflow ◽  
Patient Reported ◽  
Symptom Scores

Background Intranasal corticosteroids (INCS), oral antihistamines (POAH), and allergen-specific immunotherapy (ASIT) are widely used in the treatment of allergic rhinitis (AR); however, appraisal of treatment effect has been heterogenous, and few studies have interpreted these outcomes in context with measures of nasal airflow. Objective To provide a systematic review and meta-analysis of randomized placebo-controlled trials for common therapy classes for AR to assess standardized treatment effect on validated patient-reported outcomes and physiologic measures of airflow. Methods A systematic search was performed in PubMed, Scopus, OVID, and Cochrane library databases to identify randomized controlled trials meeting inclusion criteria. Treatment effects of INCS, POAH, and ASIT on total nasal symptom score (TNSS), visual analog scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and peak nasal inspiratory flow (PNIF) were analyzed by meta-analysis. Results Twenty-two studies with 4673 AR patients were identified, with 5 INCS, 8 POAH, and 9 ASIT trials. INCS improved TNSS (mean difference [MD] 0.90; P = .002) and PNIF (MD 13.31 L/min [ P = .0007]. POAH improved quality of life assessed by RQLQ [MD 0.36; P < .001], but no improvement was found in PNIF. ASIT improved RQLQ [MD 0.65; P < .001], with a trend toward improvement in TNSS. Conclusion Overall, INCS resulted in a clinically and statistically meaningful improvement in symptom scores and physiologic measures in AR. POAH and ASIT both improved symptom scores and quality of life, but their impacts upon nasal airflow are uncertain. There is a lack of studies assessing the effect of INCS on quality of life and the effect of POAH on symptom severity, particularly for mild AR. Future studies should assess the effect of treatment for each of these patient-reported measures.

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