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 progression of the disease. Design: A double-blind, randomized, parallel-group, placebo-controlled, 12-week study at a single center. Setting: A tertiary referral center in London, England. Patients: Thirty-four patients with severe polyposis listed for endoscopic surgical treatment. Intervention: By random allocation, fluticasone propionate aqueous nasal spray (FPANS), 200 mu g twice a day; beclomethasone dipropionate aqueous 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 results of acoustic rhinometry, the polyp score, the peak nasal inspiratory 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 compared with placebo (P less than or equal to.01) at the end of treatment. The percentage change in the mean morning peak nasal inspiratory flow rate was greater in the FPANS-treated group, with a significant effect observed at week 2 (P=.01). Nasal blockage was significantly decreased in both active groups compared with the group receiving placebo. No significant difference was observed between the treatment groups in the number of patients requiring polypectomy. Conclusions: Fluticasone and beclomethasone aqueous nasal sprays are effective in treating the symptoms of severe nasal polyps. There was some evidence that the group treated with FPANS responded more quickly to intervention and that the magnitude of the response was greater than in the group receiving beclomethasone.