TOPLINE

Medical therapy significantly reduced all nasal discharge symptoms in patients with chronic rhinosinusitis (CRS), with benefits observed in both patients with nasal polyps and those without nasal polyps; however, the degree of reduction was greater in patients with polyps.

METHODOLOGY

• Researchers evaluated the magnitude of change in the symptoms of nasal discharge in response to medical treatment in a systematic review and meta-analysis of 19 studies involving 1758 patients with CRS (mean age, 46.4 years; 57.8% men).
• The included participants had nasal discharge scores recorded before and after medical treatment; nasal discharge was assessed using four Sino-Nasal Outcome Test-22 (SNOT-22) items — “need to blow nose,” “runny nose,” “postnasal discharge,” and “thick nasal discharge” — with corresponding Visual Analog Scale (VAS) scores recorded when available.
• Patients were categorized by nasal polyp status, whereas medical therapies were categorized as biologic therapies, nonbiologic therapies (further classified as standard medical treatment or alternative treatment), or placebo.
• A subgroup analysis compared biologic therapy with standard medical treatment exclusively among patients with nasal polyps.

TAKEAWAY

• Medical therapy led to a substantial reduction in total SNOT-22 scores, with a mean decrease of 23.9 points (95% CI, 12.0-35.8), corresponding to a reduction of slightly less than 50%. All four nasal discharge items showed reductions of 1.1-1.4 points, exceeding the 0.8-point minimal clinically important difference.
• Among different types of therapies, biologics produced the greatest reductions in total SNOT scores (mean decrease, 44.1 points; 95% CI, 29.9-58.3). Biologics also led to a 52.0-point reduction in VAS postnasal discharge scores, which was significantly greater than reductions with standard medical treatment (P = .006), alternative treatment (P < .0001), and placebo (P = .0001).
• Reductions in total SNOT-22 scores were greater in patients with nasal polyps (-27 points; 95% CI, -39.2 to -14.7) than in those without (-9.6 points; 95% CI, -15.7 to -3.6).
• Only patients with nasal polyps showed a significant reduction in VAS postnasal discharge (-30.1 points; 95% CI, -47.5 to -12.7).

IN PRACTICE

“In CRS, medical therapy improves all nasal discharge types captured on the SNOT-22. Patients with and without nasal polyps benefit from medical therapy,” the authors wrote. “Biologic therapy is more effective in treating nasal discharge compared to standard medical treatment in patients with polyps,” they added.

SOURCE

Shaun A. Nguyen, MD, with the Medical University of South Carolina, Charleston, South Carolina, was the corresponding author of the study, which was published online on August 5 in the American Journal of Rhinology & Allergy.

LIMITATIONS

Few included studies reported itemized nasal discharge data, limiting the data available for analysis. Data on VAS scores were derived mainly from pain research, potentially limiting their direct applicability to nasal discharge. Discrete patient-level data came from a small population of patients who had not previously responded to treatment.

DISCLOSURES

The authors did not receive any funding for the study. Two authors disclosed serving as consultants for multiple pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.