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. 2025 Jan;80(1):94-105.
doi: 10.1111/all.16384. Epub 2024 Nov 16.

Efficacy and safety of intranasal medications for allergic rhinitis: Network meta-analysis

Bernardo Sousa-Pinto  1   2 , Rafael José Vieira  1   2 , Antonio Bognanni  3   4 , Sara Gil-Mata  1   2 , Renato Ferreira-da-Silva  1   2 , André Ferreira  2   5   6 , António Cardoso-Fernandes  1   2 , Henrique Ferreira-Cardoso  1   2 , Manuel Marques-Cruz  1   2 , Vítor Henrique Duarte  1   2 , João Castro-Teles  1   2 , Miguel Campos-Lopes  1   2 , Ana Teixeira-Ferreira  1   2 , Nuno Lourenço-Silva  1   2 , Ivan Chérrez-Ojeda  7   8 , Anna Bedbrook  9 , Ludger Klimek  10   11 , Juan Jose Yepes Nuñez  12   13 , Torsten Zuberbier  14   15 , João A Fonseca  1   2 , Holger J Schünemann  3   4 , Jean Bousquet  14   15   16 ; ARIA 2024 guideline panel
Collaborators, Affiliations

Efficacy and safety of intranasal medications for allergic rhinitis: Network meta-analysis

Bernardo Sousa-Pinto et al. Allergy. 2025 Jan.

Abstract

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.

Keywords: allergic rhinitis; antihistamines; corticosteroids; intranasal medications; network meta‐analysis; systematic review.

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References

REFERENCES

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