EFFECT OF FLUTICASONE IN SEVERE POLYPOSIS

Objectives: To investigate the effect of intranasal corticosteroids in the treatment of polyps in patients with severe polyposis listed for surgical treatment and to determine the treatment effect on the progre ssion of the disease. Design: A double-blind, randomized, parallel-gro up, placebo-controlled, 12-week study at a single center. Setting: A t ertiary referral center in London, England. Patients: Thirty-four pati ents with severe polyposis listed for endoscopic surgical treatment. I ntervention: By random allocation, fluticasone propionate aqueous nasa l spray (FPANS), 200 mu g twice a day; beclomethasone dipropionate aqu eous nasal spray, 200 mu g twice a day; or placebo nasal spray twice a day was administered. Patients received 2 actuations to each nostril in the morning and in the evening. Main Outcome Measures: Efficacy end points were the need for polypectomy at the end of treatment, the res ults of acoustic rhinometry, the polyp score, the peak nasal inspirato ry flow rate, and an assessment of symptoms. Results: The polyp score was significantly decreased in the FPANS-treated group (P less than or equal to.01). The nasal cavity volume was significantly increased in both the FPANS-treated group and the group receiving beclomethasone co mpared with placebo (P less than or equal to.01) at the end of treatme nt. The percentage change in the mean morning peak nasal inspiratory f low rate was greater in the FPANS-treated group, with a significant ef fect observed at week 2 (P=.01). Nasal blockage was significantly decr eased in both active groups compared with the group receiving placebo. No significant difference was observed between the treatment groups i n the number of patients requiring polypectomy.Conclusions: Fluticason e and beclomethasone aqueous nasal sprays are effective in treating th e symptoms of severe nasal polyps. There was some evidence that the gr oup treated with FPANS responded more quickly to intervention and that the magnitude of the response was greater than in the group receiving beclomethasone.