Peters Anju T, Pinto Jayant M, Buchheit Kathleen M, Reitsma Sietze, Thamboo Andrew, Fujieda Shigeharu, Corbett Mark, Zaccone Eric, Radwan Amr, Rowe Paul J, Deniz Yamo
From the Allergy-Immunology Division and the Sinus and Allergy Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
Allergy Asthma Proc. 2025 Sep 1;46(5):406-413. doi: 10.2500/aap.2025.46.250050.
Systemic corticosteroids (SCS) are widely used to treat patients with chronic rhinosinusitis with nasal polyps (CRSwNP) that is insufficiently controlled with first-line treatments. However, such treatment must be balanced against the risk of adverse effects with protracted or repeated use. Increasing awareness of these adverse effects and the introduction of biologics are changing established management approaches. The objective was to review the role of SCS in the management of CRSwNP in the evolving treatment landscape. A literature search was conducted for salient articles on SCS in CRSwNP, including guidelines. SCS reduce inflammation through broad actions on various immune mediators. Short courses of SCS improve symptoms (especially olfactory function) and reduce polyp size, benefits that do not persist long-term after treatment ends. SCS are widely used before endoscopic sinus surgery to improve the visibility of the surgical field and after surgery to improve outcomes, although evidence for benefit of postsurgical SCS is lacking. Adverse effects associated with SCS can manifest in a wide range of organs and systems. Use of SCS in patients with CRSwNP is associated with an increased risk of avascular necrosis, pneumonia, obesity, anxiety and/or depression, fracture, sleep apnea, hypothalamic-pituitary-adrenal axis suppression, diabetes, and hypertension. The SCS dosage regimen for CRSwNP is not well defined, and there is wide variation in clinical practice. Clinical guidelines refer to "short courses" of SCS but provide minimal guidance and lack consensus. Biologic treatments for CRSwNP have well-documented steroid-sparing effects, but the extent to which biologics might be able to reduce the use of or replace SCS may depend on economics as well as relative benefit-to-risk ratios. Short courses of SCS are widely used in patients with CRSwNP, but their use must be balanced against the risk of adverse effects. Use of biologics may reduce the use of SCS in CRSwNP, minimizing these adverse effects.
全身用糖皮质激素（SCS）被广泛用于治疗一线治疗控制不佳的慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者。然而，这种治疗必须与长期或反复使用带来的不良反应风险相权衡。对这些不良反应的认识不断提高以及生物制剂的引入正在改变既定的管理方法。目的是回顾SCS在不断演变的CRSwNP治疗格局中的作用。针对CRSwNP中有关SCS的重要文章进行了文献检索，包括指南。SCS通过对各种免疫介质的广泛作用来减轻炎症。短期使用SCS可改善症状（尤其是嗅觉功能）并缩小息肉大小，但治疗结束后这些益处不会长期持续。SCS在内镜鼻窦手术前被广泛用于改善手术视野，在手术后用于改善疗效，尽管缺乏术后使用SCS有益的证据。与SCS相关的不良反应可表现在广泛的器官和系统中。CRSwNP患者使用SCS与无血管性坏死、肺炎、肥胖、焦虑和/或抑郁、骨折、睡眠呼吸暂停、下丘脑-垂体-肾上腺轴抑制、糖尿病和高血压风险增加相关。CRSwNP的SCS给药方案尚未明确界定，临床实践中存在很大差异。临床指南提及SCS的“短期疗程”，但提供的指导很少且缺乏共识。CRSwNP的生物治疗具有充分记录的激素节省作用，但生物制剂能够减少SCS使用或替代SCS的程度可能取决于经济因素以及相对的效益风险比。短期疗程的SCS在CRSwNP患者中被广泛使用，但其使用必须与不良反应风险相权衡。使用生物制剂可能会减少CRSwNP患者中SCS的使用，从而将这些不良反应降至最低。
