The aim of this review was to compare the efficacy, safety, patient preference, and cost-effectiveness of once-daily budesonide aqueous nasal spray (BANS), fluticasone propionate nasal spray (FPNS), mometasone furoate nasal spray (MFNS), and triamcinolone aqueous nasal spray (TANS) for treatment of allergic rhinitis (AR) in adult patients.
Methods
A MEDLINE search (1966 to January 2004) was conducted to identify potentially relevant English language articles. Pertinent abstracts from recent allergy society meetings were identified also. The medical subject heading search terms included were intranasal corticosteroid (INS), nasal steroid, BANS, MFNS, FPNS, or TANS and AR. Selected studies were randomized, controlled, comparison trials of patients with AR treated with once-daily BANS, MFNS, FPNS, or TANS.
Results
All four INSs administered once daily were effective and well tolerated in the treatment of AR in adult patients, with similar efficacy and adverse event profiles. No differences were seen between INSs in systemic effects, except for significantly lower overnight urinary cortisol levels in healthy volunteers treated with FPNS compared with placebo. Based on sensory attributes, patients preferred BANS and TANS versus MFNS and FPNS. BANS was associated with more days of treatment per prescription at a lower cost per day for adults compared with the other INSs and is the only INS with a pregnancy category B rating.
Conclusion
BANS, FPNS, MFNS, and TANS have similar efficacy and safety profiles. Differences in sensory attributes, documented safety during pregnancy, and cost may contribute to better patient acceptance of one INS versus another and promote better adherence to therapy.
DykewiczM.S., FinemanS., SkonerD.P.Diagnosis and management of rhinitis: Complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology. American Academy of Allergy, Asthma, and Immunology.Ann Allergy Asthma Immunol81: 478–518, 1998.
2.
SlyR.M.Changing prevalence of allergic rhinitis and asthma.Ann Allergy Asthma Immunol82: 233–248, 1999.
3.
SpectorS.L.Overview of comorbid associations of allergic rhinitis.J Allergy Clin Immunol99: S773–S780, 1997.
4.
BousquetJ., BullingerM., FayolC.Assessment of quality of life in patients with perennial allergic rhinitis with the French version of the SF-36 Health Status Questionnaire.J Allergy Clin Immunol94: 182–188, 1994.
5.
RossR.N.The costs of allergic rhinitis.Am J Managed Care2: 285–290, 1996.
6.
McMenaminP.Costs of hay fever in the United States in 1990.Ann Allergy73: 35–39, 1994.
7.
NashD.B., SullivanS.D., and MackowiakJ.Optimizing quality of care and cost effectiveness in treating allergic rhinitis in a managed care setting.Am J Manag Care6: S3–S15, S19–S20, 2000.
8.
BousquetJ., Van CauwenbergeP., KhaltaevN.Allergic rhinitis and its impact on asthma.J Allergy Clin Immunol108: S147–S334, 2001.
9.
van CauwenbergeP., BachertC., PassalacquaG.for the European Academy of Allergology and Clinical Immunology. Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology.Allergy55: 116–134, 2000.
10.
NathanR.A.Pharmacotherapy for allergic rhinitis: A critical review of leukotriene receptor antagonists compared with other treatments.Ann Allergy Asthma Immunol90: 182–190, 2003.
11.
NielsenL.P., MygindN., and DahlR.Intranasal corticosteroids for allergic rhinitis: Superior relief?Drugs61: 1563–1579, 2001.
12.
WeinerJ.M., AbramsonM.J., and PuyR.M.Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: Systematic review of randomised controlled trials.BMJ317: 1624–1629, 1998.
13.
YanezA., and RodrigoG.J.Intranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis: A systematic review with meta-analysis.Ann Allergy Asthma Immunol89: 479–484, 2002.
14.
VinerA.S., and JackmanN.Retrospective survey of 1271 patients diagnosed as perennial rhinitis.Clin Allergy6: 251–259, 1976.
LaForceC.Use of nasal steroids in managing allergic rhinitis.J Allergy Clin Immunol103: S388–S394, 1999.
17.
CorrenJ.Intranasal corticosteroids for allergic rhinitis: How do different agents compare?J Allergy Clin Immunol104: S144–S149, 1999.
18.
DupclayL.Jr., and DoyleJ.Assessment of intranasal corticosteroid use in allergic rhinitis: Benefits, costs, and patient preferences.Am J Manag Care8: S335–S340, 2002.
19.
NormanP.Outlook for the allergic rhinitis market through 2011.Decision Resources 17.11–17.19, Dec. 3, 2002.
20.
ReissmanD., PriceT., and LeibmanC.W.Cost efficiency of intranasal corticosteroid prescribing patterns in the management of allergic rhinitis.J Manag Care Pharm10: S9–S13, 2004.
21.
CreticosP., FiremanP., SettipaneG.Intranasal budesonide aqueous pump spray (Rhinocort aqua) for the treatment of seasonal allergic rhinitis. Rhinocort Aqua Study Group.Allergy Asthma Proc19: 285–294, 1998.
22.
AnderssonM., SvenssonC., PerssonC.Dose-dependent effects of budesonide aqueous nasal spray on symptoms in a daily nasal allergen challenge model.Ann Allergy Asthma Immunol85: 279–283, 2000.
23.
DayJ.H., BriscoeM.P., RafeiroE.A single-dose of budesonide 64 μg (Rhinocort Aqua) is effective for severe allergic rhinitis symptoms in a controlled pollen exposure setting.J Allergy Clin Immunol107: S313, 2001 (Abs 1024).
24.
DayJ.H., BriscoeM.P., RafeiroE.Onset of action of intranasal budesonide (Rhinocort Aqua) in seasonal allergic rhinitis studied in a controlled exposure model.J Allergy Clin Immunol105: 489–494, 2000.
25.
ForesiA., PelucchiA., GhersonG.Once daily intranasal fluticasone propionate (200 micrograms) reduces nasal symptoms and inflammation but also attenuates the increase in bronchial responsiveness during the pollen season in allergic rhinitis.J Allergy Clin Immunol98: 274–282, 1996.
26.
NathanR.A., BronskyE.A., FiremanP.Once daily fluticasone propionate aqueous nasal spray is an effective treatment for seasonal allergic rhinitis.Ann Allergy67: 332–338, 1991.
27.
DolovichJ., WongA.G., ChodirkerW.B.Multicenter trial of fluticasone propionate aqueous nasal spray in ragweed allergic rhinitis.Ann Allergy73: 147–153, 1994.
28.
LaForceC.F., DockhornR.J., FindlayS.R.Fluticasone propionate: An effective alternative treatment for seasonal allergic rhinitis in adults and adolescents.J Fam Pract38: 145–152, 1994.
29.
BronskyE.A., AaronsonD.W., BerkowitzR.B.Dose ranging study of mometasone furoate (Nasonex) in seasonal allergic rhinitis.Ann Allergy Asthma Immunol79: 51–56, 1997.
30.
GawchikS., GoldsteinS., PrennerB.Relief of cough and nasal symptoms associated with allergic rhinitis by mometasone furoate nasal spray.Ann Allergy Asthma Immunol90: 416–421, 2003.
31.
BerkowitzR.B., RobersonS., ZoraJ.Mometasone furoate nasal spray is rapidly effective in the treatment of seasonal allergic rhinitis in an outdoor (park), acute exposure setting.Allergy Asthma Proc20: 167–172, 1999.
32.
BerkowitzR.B., BernsteinD.I., LaForceC.Onset of action of mometasone furoate nasal spray (NASONEX) in seasonal allergic rhinitis.Allergy54: 64–69, 1999.
33.
MunkZ.M., LaForceC., FurstJ.A.Efficacy and safety of triamcinolone acetonide aqueous nasal spray in patients with seasonal allergic rhinitis.Ann Allergy Asthma Immunol77: 277–281, 1996.
34.
SettipaneG., KorenblatP.E., WinderJ.Triamcinolone acetonide aqueous nasal spray in patients with seasonal ragweed allergic rhinitis: A placebo-controlled, double-blind study.Clin Ther17: 252–263, 1995.
35.
GrossG., JacobsR.L., WoodworthT.H.Comparative efficacy, safety, and effect on quality of life of triamcinolone acetonide and fluticasone propionate aqueous nasal sprays in patients with fall seasonal allergic rhinitis.Ann Allergy Asthma Immunol89: 56–62, 2002.
36.
BergerW.E., KaiserH., GawchikS.M.Triamcinolone acetonide aqueous nasal spray and fluticasone propionate are equally effective for relief of nasal symptoms in patients with seasonal allergic rhinitis.Otolaryngol Head Neck Surg129: 16–23, 2003.
37.
Ahlström-EmanuelssonC., PerssonC.G., SvenssonC.Establishing a model of seasonal allergic rhinitis and demonstrating dose-response to a topical glucocorticosteroid.Ann Allergy Asthma Immunol89: 159–165, 2002.
38.
SternM.A., DahlR., NielsenL.P.A comparison of aqueous suspensions of budesonide nasal spray (128 micrograms and 256 micrograms once daily) and fluticasone propionate nasal spray (200 micrograms once daily) in the treatment of adult patients with seasonal allergic rhinitis.Am J Rhinol11: 323–330, 1997.
39.
MeltzerE.O.Clinical and antiinflammatory effects of intranasal budesonide aqueous pump spray in the treatment of perennial allergic rhinitis.Ann Allergy Asthma Immunol81: 128–134, 1998.
40.
BanovC.H., WoehlerT.R., LaForceC.F.Once daily intranasal fluticasone propionate is effective for perennial allergic rhinitis.Ann Allergy73: 240–246, 1994.
41.
van AsA., BronskyE.A., DockhornR.J.Once daily fluticasone propionate is as effective for perennial allergic rhinitis as twice daily beclomethasone dipropionate.J Allergy Clin Immunol91: 1146–1154, 1993.
42.
DrouinM., YangW.H., BertrandB.Once daily mometasone furoate aqueous nasal spray is as effective as twice daily beclomethasone dipropionate for treating perennial allergic rhinitis patients.Ann Allergy Asthma Immunol77: 153–160, 1996.
43.
StormsW., BronskyE., FindlayS.Once daily triamcinolone acetonide nasal spray is effective for the treatment of perennial allergic rhinitis.Ann Allergy66: 329–334, 1991.
44.
KobayashiR.H., BeaucherW.N., KoepkeJ.W.Triamcinolone acetonide aqueous nasal spray for the treatment of patients with perennial allergic rhinitis: A multicenter, randomized, double-blind, placebo-controlled study.Clin Ther17: 503–513, 1995.
45.
DayJ., and CarrilloT.Comparison of the efficacy of budesonide and fluticasone propionate aqueous nasal spray for once daily treatment of perennial allergic rhinitis.J Allergy Clin Immunol102: 902–908, 1998.
46.
BendeM., CarrilloT., VónaI.A randomized comparison of the effects of budesonide and mometasone furoate aqueous nasal sprays on nasal peak flow rate and symptoms in perennial allergic rhinitis.Ann Allergy Asthma Immunol88: 617–623, 2002.
47.
MandlM., NolopK., and LutskyB.N.Comparison of once daily mometasone furoate (Nasonex) and fluticasone propionate aqueous nasal sprays for the treatment of perennial rhinitis. 194–079 Study Group.Ann Allergy Asthma Immunol79: 370–378, 1997.
48.
WilsonA.M., McFarlaneL.C., and LipworthB.J.Effects of repeated once daily dosing of three intranasal corticosteroids on basal and dynamic measures of hypothalamic-pituitary-adrenal-axis activity.J Allergy Clin Immunol101: 470–474, 1998.
49.
WilsonA.M., SimsE.J., McFarlaneL.C.Effects of intranasal corticosteroids on adrenal, bone, and blood markers of systemic activity in allergic rhinitis.J Allergy Clin Immunol102: 598–604, 1998.
50.
GrahnenA., EckernasS.A., BrundinR.M.An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers.Br J Clin Pharmacol38: 521–525, 1994.
51.
LonneboA., GrahnenA., JanssonB.An assessment of the systemic effects of single and repeated doses of inhaled fluticasone propionate and inhaled budesonide in healthy volunteers.Eur J Clin Pharmacol49: 459–463, 1996.
52.
ThorssonL., DahlstromK., EdsbackerS.Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects.Br J Clin Pharmacol43: 155–161, 1997.
53.
NaclerioR.M., BaroodyF.M., BidaniN.A comparison of nasal clearance after treatment of perennial allergic rhinitis with budesonide and mometasone.Otolaryngol Head Neck Surg128: 220–227, 2003.
54.
MahadeviaP.J., ShahS., LeibmanC.Patient preferences for sensory attributes of intranasal corticosteroids and willingness to adhere to prescribed therapy for allergic rhinitis: A conjoint analysis.Ann Allergy Asthma Immunol93: 345–350, 2004.
55.
GersonI., GreenL., and FishkenD.Patient preference and sensory comparisons of nasal spray allergy medications.J Sens Stud14: 491–496, 1999.
56.
BachertC., and El-AkkadT.Patient preferences and sensory comparisons of three intranasal corticosteroids for the treatment of allergic rhinitis.Ann Allergy Asthma Immunol89: 292–297, 2002.
57.
StokesM., AmorosiS.L., ThompsonD.Evaluation of patients’ preferences for triamcinolone acetonide aqueous, fluticasone propionate, and mometasone furoate nasal sprays in patients with allergic rhinitis.Otolaryngol Head Neck Surg131: 225–231, 2004.
58.
ShahS.R., MillerC., PethickN.Two multicenter, randomized, single-blind, single-dose, crossover studies of specific sensory attributes of budesonide aqueous nasal spray and fluticasone propionate nasal spray.Clin Ther25: 2198–2214, 2003.
59.
LennoxR.D., FowlerI., GoreM.Psychometric validation of a patient-reported sensory perception and preference instrument: The Sensory Perceptions Questionnaire.Adv Ther21: 162–172, 2004.
60.
MygindN.Glucocorticosteroids and rhinitis.Allergy48: 476–490, 1993.
61.
BernsteinI.L.Is the use of benzalkonium chloride as a preservative for nasal formulations a safety concern? A cautionary note based on compromised mucociliary transport.J Allergy Clin Immunol105: 39–44, 2000.
62.
StanalandB.E.Once-daily budesonide aqueous nasal spray for allergic rhinitis: A review.Clin Ther26: 473–492, 2004.
63.
StåhlE., van RompayW., WangE.C.Cost-effectiveness analysis of budesonide aqueous nasal spray and fluticasone propionate nasal spray in the treatment of perennial allergic rhinitis.Ann Allergy Asthma Immunol84: 397–402, 2000.
64.
SuissaS., BaltzanM., KremerR.Inhaled and nasal corticosteroid use and the risk of fracture.Am J Respir Crit Care Med169: 83–88, 2004.
65.
LindqvistN., BalleV.H., KarmaP.Long-term safety and efficacy of budesonide nasal aerosol in perennial rhinitis. A 12-month multicentre study.Allergy41: 179–186, 1986.
66.
PipkornU., PukanderJ., SuonpaaJ.Long-term safety of budesonide nasal aerosol: A 5.5-year follow-up study.Clin Allergy18: 253–259, 1988.
67.
MöllerC., AhlstromH., HenricsonK.A.Safety of nasal budesonide in the long-term treatment of children with perennial rhinitis.Clin Exp Allergy33: 816–822, 2003.
68.
MöllerC., LarsE., and SvenssonI.Nasal budesonide to children for 5 years.Allergy Clin Immunol News2: 427, 1994 (Abs 1546).
69.
MurphyK., UryniakT., SimpsonB.Recommended once-daily dose of budesonide aqueous nasal spray (Rhinocort Aqua) does not suppress growth velocity in pediatric patients with perennial allergic rhinitis.J Allergy Clin Immunol113: S175, 2004.
70.
USFDA labeling and prescription drug advertising: Content and format for labeling for human prescription drugs.Fed Regist44: 37434–37467, 1979.
71.
NorjavaaraE., and de VerdierM.G.Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide.J Allergy Clin Immunol111: 736–742, 2003.
72.
KallenB., RydhstroemH., and AbergA.Congenital malformations after the use of inhaled budesonide in early pregnancy.Obstet Gynecol93: 392–395, 1999.
73.
KallenA., and ThorssonL.Drug disposition analysis: A comparison between budesonide and fluticasone.J Pharmacokinet Pharmacodyn30: 239–256, 2003.
