1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA.
2 Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA.
Otolaryngol Head Neck Surg. 2019 Jul;161(1):18-27. doi: 10.1177/0194599819832277. Epub 2019 Feb 19.
Intranasal corticosteroids (INCSs) are widely utilized for the treatment of allergic rhinitis. Epistaxis is a known adverse effect of INCSs, but it is not known if the risk of epistaxis differs among INCSs.
Systematic review of primary studies identified through Medline, Embase, Web of Science, PubMed Central, and Cochrane databases.
Systematic review was conducted according to the PRISMA standard. English-language studies were queried through February 1, 2018. The search identified randomized controlled trials of INCSs for treatment of allergic rhinitis that reported incidence of epistaxis. An itemized assessment of the risk of bias was conducted for each included study, and meta-analysis was performed of the relative risk of epistaxis for each INCS.
Of 949 identified studies, 72 met the criteria for analysis. Meta-analysis demonstrated an overall relative risk of epistaxis of 1.48 (95% CI, 1.32-1.67) for all INCSs. The INCSs associated with the highest risk of epistaxis were beclomethasone hydrofluoroalkane, fluticasone furoate, mometasone furoate, and fluticasone propionate. Beclomethasone aqueous, ciclesonide hydrofluoroalkane, and ciclesonide aqueous were associated with the lowest risk of epistaxis. Conclusions about epistaxis with use of budesonide, triamcinolone, and flunisolide are limited due to the low number of studies and high heterogeneity.
While a differential effect on epistaxis among INCS agents is not clearly demonstrated, this meta-analysis does confirm an increased risk of epistaxis for patients using INCSs as compared with placebo for treatment of allergic rhinitis.
鼻内皮质类固醇（INCS）广泛用于治疗过敏性鼻炎。鼻出血是 INCS 的已知不良反应，但尚不清楚 INCS 之间的鼻出血风险是否不同。
通过 Medline、Embase、Web of Science、PubMed Central 和 Cochrane 数据库系统地综述了初级研究。
根据 PRISMA 标准进行系统综述。通过 2018 年 2 月 1 日检索英语语言研究。该搜索确定了 INCS 治疗过敏性鼻炎的随机对照试验，报告了鼻出血的发生率。对每一项纳入研究进行了风险偏倚的分项评估，并对每种 INCS 的鼻出血相对风险进行了荟萃分析。
在 949 项确定的研究中，有 72 项符合分析标准。荟萃分析显示，所有 INCS 的总体鼻出血相对风险为 1.48（95%CI，1.32-1.67）。与鼻出血风险最高相关的 INCS 是丙酸氟替卡松、糠酸氟替卡松、糠酸莫米松和丙酸氟替卡松。布地奈德水、环索奈德水和环索奈德氢氟烷烃与鼻出血风险最低相关。由于研究数量少且异质性高，关于使用倍氯米松、曲安奈德和氟尼缩松引起的鼻出血的结论有限。
虽然 INCS 药物之间对鼻出血的影响差异不明显，但这项荟萃分析确实证实，与安慰剂相比，INCS 治疗过敏性鼻炎的患者发生鼻出血的风险增加。
