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Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis.
Otolaryngol Head Neck Surg. 2019 09; 161(3):412-418.OH

Abstract

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.

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Authors+Show Affiliations

Debbaneh PM
1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Bareiss AK
1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Wise SK
2 Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.
McCoul ED
1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. 3 Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA. 4 Ochsner Clinic Foundation, Department of Otorhinolaryngology, New Orleans, Louisiana, USA.

MeSH

Administration, IntranasalAnti-Allergic AgentsDrug CombinationsFluticasoneHumansPhthalazinesRandomized Controlled Trials as TopicRhinitis, Allergic

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

30961435

Citation

Debbaneh, Peter M., et al. "Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 161, no. 3, 2019, pp. 412-418.
Debbaneh PM, Bareiss AK, Wise SK, et al. Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2019;161(3):412-418.
Debbaneh, P. M., Bareiss, A. K., Wise, S. K., & McCoul, E. D. (2019). Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 161(3), 412-418. https://doi.org/10.1177/0194599819841883
Debbaneh PM, et al. Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2019;161(3):412-418. PubMed PMID: 30961435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis. AU - Debbaneh,Peter M, AU - Bareiss,Anna K, AU - Wise,Sarah K, AU - McCoul,Edward D, Y1 - 2019/04/09/ PY - 2019/4/10/pubmed PY - 2020/1/31/medline PY - 2019/4/10/entrez KW - allergic rhinitis KW - azelastine KW - fluticasone KW - systematic review SP - 412 EP - 418 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 161 IS - 3 N2 - 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. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/30961435/Intranasal_Azelastine_and_Fluticasone_as_Combination_Therapy_for_Allergic_Rhinitis:_Systematic_Review_and_Meta_analysis_ L2 - http://journals.sagepub.com/doi/full/10.1177/0194599819841883?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -

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