"REAL WORLD PRESCRIBING PATTERNS AND OUTCOMES OF INTRANASAL CORTICOSTEROIDS IN CHRONIC RHINOSINUSITIS: A POPULATION-BASED COHORT STUDY."
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Keywords
Chronic rhinosinusitis, Intranasal corticosteroids, Prescribing patterns, Mometasone furoate, Fluticasone propionate, Real-world evidence, SNOT-22 score, Adherence, EPOS 2020.
Abstract
Background: Chronic rhinosinusitis (CRS) is a multifactorial inflammatory condition of the nasal and paranasal mucosa lasting beyond 12 weeks, significantly impairing quality of life and productivity. Intranasal corticosteroids (INCS) form the cornerstone of CRS management due to their potent anti-inflammatory action, mucosal decongestion, and symptom control. Despite strong clinical guideline recommendations, real-world adherence to INCS therapy, variations in prescribing patterns, and clinical outcomes remain underexplored in the Indian population context. This study sought to evaluate population-level prescribing trends and treatment outcomes of INCS therapy in CRS under routine clinical practice.
Objectives: To assess the prescribing patterns, adherence, and clinical outcomes of intranasal corticosteroid therapy in patients with chronic rhinosinusitis across tertiary and secondary care centers in South India.
Methods: A real-world, observational cohort study was conducted over a period of 6–8 months among 174 patients diagnosed with CRS as per EPOS 2020 diagnostic criteria. Data were collected from outpatient prescriptions, electronic health records, and structured patient interviews. Variables included demographic characteristics, comorbidities, types and doses of prescribed INCS (mometasone, fluticasone, budesonide, beclomethasone), concurrent therapies, adherence levels (assessed via Morisky Medication Adherence Scale), and clinical improvement (measured by SNOT-22 score reduction and endoscopic grading). Statistical analyses were performed using SPSS v26, with categorical data analyzed via chi-square tests and continuous variables using paired t-tests. A p-value <0.05 was considered statistically significant.
Results: Among 174 participants (mean age: 38.6 ± 11.4 years; male-to-female ratio: 1.3:1), mometasone furoate (36.8%) and fluticasone propionate (32.2%) were the most prescribed INCS, followed by budesonide (18.9%) and beclomethasone (12.1%). Concomitant antihistamine and saline irrigation use was noted in 62% and 57% of patients, respectively. High adherence was observed in 61.5% of subjects. Significant improvement in mean SNOT-22 scores was recorded (from 46.2 ± 13.1 at baseline to 21.8 ± 10.4 at follow-up, p < 0.001). The presence of allergic rhinitis and smoking history were negatively associated with therapeutic response (p < 0.05). Adverse effects, primarily nasal dryness and epistaxis, occurred in 9.8% of patients but did not necessitate discontinuation.
Conclusion: This real-world cohort study highlights that intranasal corticosteroids, particularly mometasone and fluticasone, are the predominant therapeutic agents in CRS management, demonstrating high effectiveness and safety profiles. Consistent adherence to therapy was strongly correlated with clinical improvement. Findings underscore the need for patient education, regular follow-up, and uniform prescribing protocols to optimize CRS outcomes in routine practice. Further large-scale multicentric studies are warranted to evaluate long-term mucosal remodeling and relapse rates.
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Dr. M. Vamshi krishna
Associate professor of ENT, Department of ENT, Government medical college, Department of ENT, Mulugu, Telangana, formerly Associate Professor of ENT, Pratima relief institute of medical sciences, Hanamkonda.
Dr. Revalle Shravan Kumar
Associate professor of ENT, Department of ENT, Prathima institute of medical sciences, Hanamkonda, Telangana
Dr Sakinala Sunil
Associate professor of ENT, Department of ENT, Prathima institute of medical sciences, Hanamkonda, Telangana