Ratner Paul H, Meltzer Eli O, Teper Ariel
Sylvana Research Associates, San Antonio, TX 78229, USA.
Int J Pediatr Otorhinolaryngol. 2009 May;73(5):651-7. doi: 10.1016/j.ijporl.2008.12.025. Epub 2009 Feb 23.
Perennial allergic rhinitis (PAR) affects children at a young age. Current guidelines recommend intranasal corticosteroids as the first-line treatment in patients with moderate-to-severe or persistent disease or in those who have congestion. In this study, the long-term safety and efficacy of mometasone furoate nasal spray (MFNS) were assessed in children with PAR.
In this multicenter, active-controlled, evaluator-blind, 12-month study, 255 children aged 6-11 years with a >or=1-year history of PAR were randomized to receive once-daily MFNS 100 microg (n=166) or the active comparator beclomethasone dipropionate (BDP) 168 microg (n=85). Changes from baseline in overall PAR symptoms and response to treatment were rated at each visit. Cosyntropin stimulation testing, as well as tonometry and slit lamp procedures, were performed. Safety variables were assessed.
A total of 137 subjects in the MFNS group and 68 in the BDP group completed treatment. The mean reductions in physician- and subject-rated overall condition of PAR at week 52 were -42.1% and -39.7%, respectively, for MFNS, compared with -44.0% and -39.0%, respectively, for BDP. A total of 94% and 100% of MFNS and BDP subjects, respectively, reported adverse events (AEs), which were mostly mild or moderate. The most frequently reported treatment-related AEs in both groups were epistaxis, headache, and pharyngitis. Response to cosyntropin was normal and no posterior subcapsular cataracts were observed in either group. Although no significant changes in intraocular pressure were observed with MFNS, one subject receiving BDP demonstrated this effect.
Treatment with MFNS 100 microg once daily for 1 year was well tolerated in children 6-11 years old, with negligible systemic exposure and no evidence of suppression of the hypothalamic-pituitary-adrenal axis or ocular changes.
常年性变应性鼻炎(PAR)在儿童幼年时即可发病。当前指南推荐,对于中重度或持续性疾病患者或有鼻塞症状的患者,鼻用糖皮质激素作为一线治疗药物。在本研究中,评估了糠酸莫米松鼻喷雾剂(MFNS)用于PAR患儿的长期安全性和疗效。
在这项多中心、活性药物对照、评估者盲法的12个月研究中,将255名6至11岁、PAR病史≥1年的儿童随机分为两组,分别每日一次接受100μg MFNS(n = 166)或活性对照药物二丙酸倍氯米松(BDP)168μg(n = 85)治疗。每次随访时对PAR总体症状与基线相比的变化及治疗反应进行评分。进行促肾上腺皮质激素刺激试验以及眼压测量和裂隙灯检查。评估安全性变量。
MFNS组共有137名受试者、BDP组共有68名受试者完成治疗。在第52周时,MFNS组医生和受试者评定的PAR总体状况平均改善率分别为-42.1%和-39.7%,而BDP组分别为-44.0%和-39.0%。MFNS组和BDP组分别有94%和100%的受试者报告了不良事件(AE),大多为轻度或中度。两组最常报告的与治疗相关的AE为鼻出血、头痛和咽炎。两组对促肾上腺皮质激素的反应均正常,且均未观察到后囊下白内障。虽然MFNS未观察到眼压有显著变化,但一名接受BDP治疗的受试者出现了这种效应。
6至11岁儿童每日一次使用100μg MFNS治疗1年耐受性良好,全身暴露可忽略不计,且无下丘脑-垂体-肾上腺轴抑制或眼部改变的证据。