Estimating the effect of nasal steroid treatment on repeat polypectomies: survival time analysis using the General Practice Research Database

Abstract

Background: Intranasal steroids are effective in preventing or delaying recurrence of nasal polyps. However, their effectiveness in delaying a need for repeat polypectomy in clinical practice is unknown.

Objectives: To compare time to a repeat polypectomy between post-polypectomy intranasal steroid users and non-users. METHODOLOGY/PRINCIPLE: Our cohort consisted of patients in GPRD who had undergone at least one nasal polypectomy procedure in or after the year 2000. These patients were followed for up to 4 years and the time to next polypectomy was estimated. Cox`s proportional hazards regression was used to estimate the effect of post polypectomy intranasal steroid treatment on time to the next polypectomy after controlling for other respiratory conditions and their treatment.

Results: The cohort consisted of 1,675 patients with a mean age of 59 years and 68% males. Of these, 576 patients were post-polypectomy steroid users and 1,099 patients were steroid non-users. The median time to repeat polypectomy was 812 days among the steroid users and 736 days among steroid non-users. Significantly less proportion of intranasal steroid users experienced a repeat polypectomy compared to steroid non-users. This difference was consistent among subgroups of females and concomitant rhinitis treatments users. Patients with post polypectomy intranasal steroid use showed lower risk for a repeat polypectomy compared to steroid non-users. Concomitant rhinitis medication users showed a higher risk whereas other confounders were not significant.

Conclusions: Intranasal steroids were effective in delaying a repeat polypectomy. However, further research using a prospective design is necessary to quantify the benefit of ongoing steroid treatment.