BACKGROUND Intranasal antihistamines (INAH), corticosteroids (INCS), and their fixed combinations (INAH+INCS) are one of the cornerstones of the treatment of allergic rhinitis (AR). We performed a systematic review and network-meta-analysis comparing the efficacy and safety of INAH, INCS, and INAH+INCS in patients with AR. METHODS We searched four electronic bibliographic databases and three clinical trial databases for randomised controlled trials assessing the use of INAH, INCS, and INAH+INCS in adults with seasonal or perennial AR. We performed a network meta-analysis on the Total Nasal Symptom Score, Total Ocular Symptom Score, Rhinoconjunctivitis Quality-of-Life Questionnaire, development of adverse events, and withdrawals due to adverse events. Certainty of evidence was assessed using GRADE-NMA. RESULTS We included 167 primary studies, most of which assessed patients with seasonal AR. Among individual medications, azelastine-fluticasone, and fluticasone furoate were the most frequently highest-ranked interventions for efficacy outcomes, being regularly associated with clinically meaningful larger improvements when compared to other active treatments. Considering drug classes, INAH+INCS were the highest-ranked interventions for all outcomes in which they were assessed, followed in most cases by INCS. In 105 out of 184 comparisons in seasonal AR, and 28 out of 97 comparisons in perennial AR, certainty of evidence was considered "high" or "moderate". CONCLUSION Intranasal medications for AR display clinically relevant differences in their efficacy, but all show a good safety profile. To our knowledge, this is the first network meta-analysis comparing INAH, INCS, and INAH+INCS in AR, providing relevant evidence for guideline developers and practising physicians on the most efficacious treatments.

中文翻译：

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鼻内药物治疗过敏性鼻炎的疗效和安全性：网络荟萃分析。


背景鼻内抗组胺药 （INAH）、皮质类固醇 （INCS） 及其固定组合 （INAH+INCS） 是治疗过敏性鼻炎 （AR） 的基石之一。我们进行了系统评价和网络荟萃分析，比较了 INAH、INCS 和 INAH+INCS 在 AR 患者中的疗效和安全性。方法 我们检索了四个电子书目数据库和三个临床试验数据库，以查找评估 INAH、INCS 和 INAH+INCS 在成人季节性或常年性 AR 患者中的使用情况的随机对照试验。我们对鼻部症状总分、眼部症状总分、鼻结膜炎生活质量问卷、不良事件的发展和因不良事件而退出的情况进行了网状meta分析。使用 GRADE-NMA 评估证据质量。结果 我们纳入了 167 项主要研究，其中大多数评估了季节性 AR 患者。在个体药物中，氮卓斯汀-氟替卡松和糠酸氟替卡松是疗效结局最常排名最高的干预措施，与其他积极治疗相比，它们通常与具有临床意义的较大改善相关。考虑到药物类别，INAH+INCS 是评估它们的所有结局中排名最高的干预措施，在大多数情况下其次是 INCS。在季节性 AR 的 184 项比较中，有 105 项，在常年性 AR 的 97 项比较中，有 28 项证据质量被认为是“高”或“中等”。结论 AR 鼻内药物的疗效存在临床相关差异，但都显示出良好的安全性。 据我们所知，这是首次比较 INAH、INCS 和 INAH+INCS 在 AR 中的网络荟萃分析，为指南制定者和执业医师提供了最有效治疗的相关证据。