PMID- 31609091
OWN - NLM
STAT- MEDLINE
DCOM- 20200601
LR  - 20200601
IS  - 2042-6984 (Electronic)
IS  - 2042-6976 (Linking)
VI  - 9
IP  - 12
DP  - 2019 Dec
TI  - Predictors of efficacy for combination oral and topical corticosteroids to treat 
      patients with chronic rhinosinusitis with nasal polyps.
PG  - 1436-1442
LID - 10.1002/alr.22431 [doi]
AB  - BACKGROUND: A short-course oral corticosteroid taper and topical intranasal 
      corticosteroids may be used to maximize the success of medical management for 
      chronic rhinosinusitis with nasal polyps (CRSwNP). In this study, we sought to 
      identify characteristics that would be predictive of efficacy for this 
      combination regimen. METHODS: Sixty-four patients with CRS, bilateral polyps, a 
      polyp score of at least 3, and a 22-item Sino-Nasal Outcome Test (SNOT-22) score 
      >/=20 were prospectively enrolled and uniformly treated with a 15-day prednisone 
      taper and twice daily dilute budesonide irrigations. Participants were assessed 
      at enrollment and at follow up, 2 to 5 months later. Clinical and demographic 
      characteristics were assessed at enrollment. At both time points, CRS symptoms 
      were assessed with SNOT-22, and polyp score (range, 0 to 6) was assessed 
      endoscopically. Associations were determined with regression. RESULTS: 
      Pretreatment SNOT-22 score (adjusted beta = -0.83; 95% CI, -1.08 to -0.58; p < 
      0.001) and comorbid asthma (adjusted beta = 15.75; 95% CI, 4.74 to 26.75; p = 0.007) 
      were associated with a change in SNOT-22 experienced over the study period. 
      Achieving a greater-than-1 minimal clinically important difference (MCID) 
      improvement in SNOT-22 score was also associated with pretreatment SNOT-22 score 
      (adjusted OR = 1.09; 95% CI, 1.04 to 1.14; p < 0.001) and comorbid asthma 
      (adjusted OR = 0.13; 95% CI, 0.03 to 0.72; p = 0.019). SNOT-22 score >/=47 had 
      81.5% sensitivity and 78.4% specificity to detect patients experiencing 1 MCID 
      improvement. Pretreatment polyp score was not associated with any outcome metric. 
      CONCLUSION: In treatment of CRSwNP with prednisone and budesonide irrigations, 
      pretreatment endoscopy was not informative of treatment response. Pretreatment 
      SNOT-22 and comorbid asthma may be more predictive.
CI  - (c) 2019 ARS-AAOA, LLC.
FAU - Epperson, Madison V
AU  - Epperson MV
AUID- ORCID: 0000-0003-0887-5111
AD  - Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati 
      College of Medicine, Cincinnati, OH.
FAU - Phillips, Katie M
AU  - Phillips KM
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University, 
      Stanford, CA.
FAU - Caradonna, David S
AU  - Caradonna DS
AD  - Department of Otolaryngology, Harvard Medical School, Boston, MA.
AD  - Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA.
FAU - Gray, Stacey T
AU  - Gray ST
AD  - Department of Otolaryngology, Harvard Medical School, Boston, MA.
AD  - Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.
FAU - Sedaghat, Ahmad R
AU  - Sedaghat AR
AUID- ORCID: 0000-0001-6331-2325
AD  - Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati 
      College of Medicine, Cincinnati, OH.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20191014
PL  - United States
TA  - Int Forum Allergy Rhinol
JT  - International forum of allergy & rhinology
JID - 101550261
RN  - 0 (Adrenal Cortex Hormones)
RN  - 51333-22-3 (Budesonide)
RN  - VB0R961HZT (Prednisone)
SB  - IM
MH  - Administration, Intranasal
MH  - Administration, Oral
MH  - Adrenal Cortex Hormones/*administration & dosage
MH  - Adult
MH  - Aged
MH  - Budesonide/*administration & dosage
MH  - Chronic Disease
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nasal Polyps/*drug therapy
MH  - Prednisone/*administration & dosage
MH  - Rhinitis/*drug therapy
MH  - Sino-Nasal Outcome Test
MH  - Sinusitis/*drug therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - CRSwNP
OT  - budesonide
OT  - chronic rhinosinusitis
OT  - corticosteroids
OT  - irrigation
OT  - polyps
OT  - treatment response
EDAT- 2019/10/15 06:00
MHDA- 2020/06/02 06:00
CRDT- 2019/10/15 06:00
PHST- 2019/07/13 00:00 [received]
PHST- 2019/08/05 00:00 [revised]
PHST- 2019/08/26 00:00 [accepted]
PHST- 2019/10/15 06:00 [pubmed]
PHST- 2020/06/02 06:00 [medline]
PHST- 2019/10/15 06:00 [entrez]
AID - 10.1002/alr.22431 [doi]
PST - ppublish
SO  - Int Forum Allergy Rhinol. 2019 Dec;9(12):1436-1442. doi: 10.1002/alr.22431. Epub 
      2019 Oct 14.