Juniper E F, Guyatt G H, Ferrie P J, Griffith L E
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Hamilton, Ont.
CMAJ. 1997 Apr 15;156(8):1123-31.
To determine whether better health-related quality of life (HRQL) is achieved by initiating treatment of seasonal (ragweed) rhinoconjunctivitis (hay fever) with a nasal steroid (fluticasone) backed up by a nonsedating antihistamine (terfenadine) or whether it is better to start with the antihistamine and add the nasal steroid when necessary.
Randomized, nonblind, parallel-group management study during the 6 weeks of the ragweed pollen season in 1995.
Sixty-one adults with ragweed pollen hay fever recruited from patients who had participated in previous clinical studies and from those who responded to notices in the local media.
Southern Ontario.
Nasal steroid group: 200 micrograms of fluticasone nasal spray when needed (up to 400 micrograms/d) starting about 1 week before the ragweed pollen season and continued throughout, with 1 to 2 tablets of terfenadine daily (maximum 120 mg/d) if needed. Antihistamine group: 1 60-mg tablet of terfenadine when needed (maximum 120 mg/d) starting about 1 week before the ragweed pollen season and continued throughout, with 200-400 micrograms/d of fluticasone nasal spray (maximum 400 micrograms/d) if needed.
HRQL before, at the height of and toward the end of the ragweed pollen season; HRQL was measured using the Rhinoconjunctivitis Quality of Life Questionnáire.
Overall, HRQL tended to be better in the group of patients whose first-line treatment was with fluticasone (p = 0.052), but the difference between the 2 groups was small and not clinically important. Just over half (52% [16/31]) of the patients in the fluticasone group did not need additional help with terfenadine, whereas only 13% (4/30) of those in the terfenadine group did not need additional help with fluticasone (p = 0.002).
There is little difference in the therapeutic benefit between the 2 approaches for the treatment of ragweed pollen hay fever. Therefore, the approach to treatment should be based on patient preference, convenience and cost. Regardless of the treatment, at least 50% of patients will need to take both types of medication in combination to control symptoms adequately.
确定对于季节性（豚草）鼻结膜炎（花粉症），以鼻用类固醇（氟替卡松）起始治疗并辅以非镇静性抗组胺药（特非那定）是否能获得更好的健康相关生活质量（HRQL），或者是否先使用抗组胺药并在必要时加用鼻用类固醇会更好。
1995年豚草花粉季节的6周内进行的随机、非盲、平行组管理研究。
从参与过既往临床研究的患者以及对当地媒体公告做出回应的患者中招募的61例患有豚草花粉症的成年人。
安大略省南部。
鼻用类固醇组：在豚草花粉季节开始前约1周按需使用200微克氟替卡松鼻喷雾剂（每日最多400微克），并持续整个季节，必要时每日服用1至2片特非那定（最大剂量120毫克/天）。抗组胺药组：在豚草花粉季节开始前约1周按需服用1片60毫克的特非那定（最大剂量120毫克/天），并持续整个季节，必要时使用200 - 400微克/天的氟替卡松鼻喷雾剂（最大剂量400微克/天）。
豚草花粉季节开始前、高峰时及接近结束时的HRQL；使用鼻结膜炎生活质量问卷测量HRQL。
总体而言，一线治疗为氟替卡松的患者组HRQL往往更好（p = 0.052），但两组之间的差异较小且无临床意义。氟替卡松组略超过一半（52% [16/31]）的患者不需要特非那定的额外帮助，而特非那定组只有13%（4/30）的患者不需要氟替卡松的额外帮助（p = 0.002）。
治疗豚草花粉症的两种方法在治疗益处上差异不大。因此，治疗方法应基于患者的偏好、便利性和成本。无论采用何种治疗方法，至少50%的患者需要联合使用两种药物才能充分控制症状。
