Rhinocort - Effective, once-daily relief of allergic rhinitis

- Is Rhinocort® an effective treatment for seasonal allergic rhinitis?
  Yes, Rhinocort® is an effective treatment for seasonal allergic rhinitis. This was confirmed in a randomised, double-blind, placebo-controlled study involving 217 patients with ragweed-sensitive, seasonal allergic rhinitis (Day et al 2000). The study showed that Rhinocort® Aqua™ 64 or 256 µg once daily significantly (p<0.05) reduced nasal symptoms after exposure to ragweed pollen, compared with placebo (Figure 1).
  Figure 1. Patients’ (n=217) overall evaluation of the efficacy of Rhinocort® Aqua™ 64 or 256 µg up to 12 hours after allergen exposure (Day et al 2000)
  
  A further study in 175 children (aged 6–17 years) and 231 adults with seasonal allergic rhinitis showed that Rhinocort® Aqua™ (32, 64, 128 and 256 µg) once daily improved nasal symptom scores compared with placebo in a 4-week randomised study (Creticos et al 1998; Figure 2a, 2b).
  Figure 2a.
  Figure 2b.Combined nasal symptom scores (a) and individual symptom scores (b) in patients with seasonal allergic rhinitis following 4-weeks of treatment with either Rhinocort® Aqua™ or placebo (Creticos et al 1998)
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- Is Rhinocort® an effective treatment for perennial allergic rhinitis?
  In 221 children (aged 6–17 years), once-daily treatment with Rhinocort® Aqua™ (32, 64, 128 and 256 µg) provided effective relief from perennial allergic rhinitis symptoms (Figure 3) and reduced markers of allergic inflammation (such as basophils and eosinophils; Figure 4) compared with placebo (Meltzer 1998).
  Figure 3. Combined nasal symptoms scores in 478 patients with perennial allergic rhinitis following treatment for 6 weeks with once-daily Rhinocort® Aqua™ or placebo (Meltzer 1998)
  Figure 4. Anti-inflammatory effects of Rhinocort® Aqua™ in patients with perennial allergic rhinitis (Meltzer 1998)
  
  Furthermore, in a 7-week study Rhinocort® Aqua™ 128 µg (n=100) improved evening peak nasal inspiratory flow (PNIF) in 202 children (aged 6–16 years) with perennial allergic rhinitis compared with placebo (Fokkens et al 2002; Figure 5).
  Figure 5. Evening peak nasal inspiratory flow (PNIF) in 202 children (6–16 years) with perennial allergic rhinitis following treatment with Rhinocort® Aqua™ 128 µg or placebo (Fokkens et al 2002)
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- How effective is Rhinocort® compared with other intranasal corticosteroids?
  In a 6-week, randomised study involving 437 adult patients with perennial allergic rhinitis, Rhinocort® Aqua™ 128 and 256 µg once daily was as effective as mometasone furoate 200 µg once daily in improving morning and evening nasal index scores (Figure 6a) and PNIF (Figure 6b) (Bende et al 2002). Furthermore, Rhinocort® 256 µg was significantly (p<0.05) more effective than mometasone furoate in improving PNIF.
  Figure 6a.
  Figure 6b. Nasal index scores (a) and morning peak nasal inspiratory flow (PNIF) (b) in 437 patients with perennial allergic rhinitis following 4 weeks treatment with once-daily Rhinocort® Aqua™ 128 or 256 µg, mometasone furoate 200 µg or placebo (Bende et al 2002)
  
  In a 4–6 week randomised study, Rhinocort® Aqua™ 256 µg once daily and fluticasone propionate 200 µg once daily were shown to be effective treatments for adults (n=602) with seasonal allergic rhinitis (Stern et al 1997). Furthermore, Rhinocort® Aqua™-treated patients had significantly (p<0.05) lower nasal symptom scores than those treated with fluticasone propionate on high pollen days (Figure 7).
  Figure 7. Mean change in combined nasal symptom scores from baseline following once-daily treatment with Rhinocort® Aqua™ 256 µg, fluticasone propionate 200 µg or placebo on ‘all’ and the ‘high pollen’ days in 602 patients with seasonal allergic rhinitis (Stern et al 1997)
  
  In patients (n=273) with perennial allergic rhinitis Rhinocort® Aqua™ 256 µg was shown to significantly reduce nasal symptoms scores compared with fluticasone propionate (p<0.05) and placebo (p<0.001) over a 6-week period (Day & Carrillo 1998; Figure 8). Furthermore, Rhinocort® Aqua™ had a faster onset of action than fluticasone propionate (Table 1).
  Figure 8. Mean reduction from baseline in combined nasal symptom scores following once-daily treatment with Rhinocort® Aqua™ 256 µg, fluticasone propionate 200 µg or placebo over a 6-week treatment period (Day & Carrillo 1998)
  Table 1. Onset of action of Rhinocort® Aqua™ 256 µg and fluticasone propionate 200 µg compared with placebo (Day & Carrillo 1998)
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- How effective is Rhinocort® compared with antihistamines?
  In a 1-year, randomised study, Rhinocort® Turbuhaler® 280 µg once daily was found to be significantly (p<0.05) more effective than oral cetirizine (10 mg) in reducing total nasal symptom scores in patients (n=143) with perennial allergic or non-allergic rhinitis (Rinne et al 2002; Figure 9). Moreover, after stopping treatment, patients who had taken Rhinocort® Turbuhaler® had fewer relapses over the following 1–2 months than patients who had taken cetirizine.
  Figure 9. Mean weekly total nasal symptom score in 143 patients with perennial allergic or non-allergic rhinitis following once-daily treatment with either Rhinocort® Turbuhaler® 280 µg or cetirizine 10 mg over a 1-year treatment period (Rinne et al 2002)
  
  Once-daily Rhinocort® Aqua™ 256 µg was shown to be significantly more effective at relieving the combined nasal symptoms of perennial allergic rhinitis, compared with placebo (p<0.001) or a twice-daily dose of azelastine 280 µg aqueous nasal spray (p<0.01) (Stern et al 1998).
  
  Furthermore, a recent, systematic review of randomised, controlled trials by Yanez & Rodrigo (2002) showed that intranasal corticosteroids for the treatment of allergic rhinitis produced greater relief of nasal symptoms and nasal blockade than topical antihistamines; though no difference in ocular symptoms was noted.
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- References
  Bende M, Carrillo T, Vona I, da Castel-Branco MG, Arheden L. A randomized comparison of the effects of budesonide and mometasone furoate aqueous nasal sprays on nasal peak flow rate and symptoms in perennial allergic rhinitis. Ann Allergy Asthma Immunol 2002; 88: 617–623.
  
  Creticos P, Fireman P, Settipane G, Bernstein D, Casale T, Schwartz H. Intranasal budesonide aqueous pump spray (Rhinocort Aqua) for the treatment of seasonal allergic rhinitis. Rhinocort Aqua Study Group. Allergy Asthma Proc 1998; 19: 285–294.
  
  Day J, Carrillo T. Comparison of the efficacy of budesonide and fluticasone propionate aqueous nasal spray for once daily treatment of perennial allergic rhinitis. J Allergy Clin Immunol 1998; 102: 902–908.
  
  Day JH, Briscoe MP, Rafeiro E, Ellis AK, Pettersson E, Åkerlund A. Onset of action of intranasal budesonide (Rhinocort aqua) in seasonal allergic rhinitis studied in a controlled exposure model. J Allergy Clin Immunol 2000; 105: 489–494.
  
  Fokkens WJ, Cserhati E, dos Santos JM, et al. Budesonide aqueous nasal spray is an effective treatment in children with perennial allergic rhinitis, with an onset of action within 12 hours. Ann Allergy Asthma Immunol 2002; 89: 279–284.
  
  Meltzer EO. Clinical and antiinflammatory effects of intranasal budesonide aqueous pump spray in the treatment of perennial allergic rhinitis. Ann Allergy Asthma Immunol 1998; 81: 128–134.
  
  Rinne J, Simola M, Malmberg H, Haahtela T. Early treatment of perennial rhinitis with budesonide or cetirizine and its effect on long-term outcome. J Allergy Clin Immunol 2002; 109: 426–432.
  
  Stern MA, Dahl R, Nielsen LP, Pedersen B, Schrewelius C. A comparison of aqueous suspensions of budesonide nasal spray (128 micrograms and 256 micrograms once daily) and fluticasone propionate nasal spray (200 micrograms once daily) in the treatment of adult patients with seasonal allergic rhinitis. Am J Rhinol 1997; 11: 323–330.
  
  Stern MA, Wade AG, Ridout SM, Cambell LM. Nasal budesonide offers superior symptom relief in perennial allergic rhinitis in comparison to nasal azelastine. Ann Allergy Asthma Immunol. 1998; 81: 354–358.
  
  Yanez A, Rodrigo GJ. Intranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 2002; 89: 479–484.
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