Monday, May 19, 2008

Which nasal corticosteriod is the best?

My short answer is "they are all equal." My long answer is based on several facts. First, I analyzed all of the published studies in the world's medical literature comparing two or more nasal corticosteroids directly. The trade names (generic chemical names in parenthesis) of the nasal corticosteroids were Beconase (beclomethasone dipropionate), Flonase (fluticasone propionate), Nasonex (mometasone furoate), Nasacort AQ (triamcinolone acetonide), Nasarel (flunisolide), Rhinocort AQ (budesonide), Vancenase (beclomethasone dipropionate), Veramyst (fluticasone furoate). This boiled down to 43 studies, after excluding hundreds of studies. Next, I examined the studies for the patients and disease severity selected, methods used, doses of medications, outcomes measured. Some were quite small and had in my opinion minimal statistical power to detect any difference at all. A true meta-analysis would be difficult to do, because hardly any of these studies were identical in any regards. I just haven't had the time to publish my "review." To summarize, no nasal corticosteroid showed superior efficacy throughout the studies. Second, other reviews in the medical literature state the same conclusion, although I have never seen an article that lists every study that I reviewed. The conclusion is usually based on 5-9 cited references. Third, if I, or any other physician, thought that one nasal corticosteroid was superior, based on our experience alone, we would all be using that nasal corticosteroid first. That does not happen in practice.

There are slight differences in the characteristics of the compounds (smell, taste) and the spray bottles. If this works for you, great. But one nasal steroid and its spray bottle does not satisfy all. In most studies, the success rate for relieving symptoms is about 75%. So by random chance, know that there's a 25% that this nasal corticosteroid is simply not the right one for you. What's the next step? Try another one.

If you have questions about using nasal corticosteroids, ask your doctor.

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