Zyryanov S K, Vozzhaev A V
Patrice Lumumba Peoples' Friendship University of Russia, Moscow, Russia.
City Clinical Hospital No. 24, Moscow, Russia.
Vestn Otorinolaringol. 2024;89(4):68-77. doi: 10.17116/otorino20248904168.
Allergic rhinitis (AR) can significantly reduce the quality of life of patients leading to increased fatigue, mood changes, cognitive impairment, and depression. In clinical practice, insufficient effectiveness of initial AR monotherapy is often noted, and a significant proportion of patients referring for medical care have moderate-severe AR. In this regard, the issues of optimization of combined pharmacological treatment of AR are becoming more and more urgent. This paper provides analysis of the opportunities of combined pharmacotherapy within the framework of current management strategy of AR. Based on the results of some studies and known pharmacological properties of medications it is being discussed the advantages of combined use of intranasal corticosteroids and leukotriene receptor antagonists, in particular mometasone furoate and montelukast, in the therapy of AR, including such comorbidities as bronchial asthma, chronic polyposis rhinosinusitis and pharyngeal tonsil hyperplasia. Some aspects of combination therapy with montelukast and second-generation systemic antihistamines as an alternative approach in case of inability to take intranasal corticosteroids, including the reasonability of using a fixed combination of montelukast and levocetirizine, are analyzed from the perspective of rational pharmacotherapy. The problem of interchangeability of brand-name and generic drugs for the treatment of AR is discussed, considering the almost complete absence of studies of their therapeutic equivalence.
变应性鼻炎（AR）会显著降低患者的生活质量，导致疲劳加剧、情绪变化、认知障碍和抑郁。在临床实践中，常常发现初始AR单一疗法的效果不佳，而且寻求医疗护理的患者中很大一部分患有中重度AR。在这方面，优化AR联合药物治疗的问题变得越来越紧迫。本文对AR当前管理策略框架内联合药物治疗的机会进行了分析。基于一些研究结果和药物已知的药理特性，讨论了鼻用糖皮质激素和白三烯受体拮抗剂（特别是糠酸莫米松和孟鲁司特）联合使用在AR治疗中的优势，包括支气管哮喘、慢性鼻息肉鼻窦炎和咽扁桃体增生等合并症。从合理药物治疗的角度分析了孟鲁司特与第二代全身性抗组胺药联合治疗作为无法使用鼻用糖皮质激素时的替代方法的一些方面，包括使用孟鲁司特和左西替利嗪固定组合的合理性。考虑到几乎完全缺乏关于品牌药和仿制药治疗AR的治疗等效性研究，讨论了它们在治疗AR方面的可互换性问题。
