Long-term study of fluticasone propionate aqueous nasal spray in acute and maintenance therapy of nasal polyposis

Topical steroids are first-line medication to control nasal polyposis (NP), a disease with long-term clinical course. The aim of this study was to evaluate the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 μg twice a day (bd) after 1 month of treatment, and to compare FPANS 200 μg bd and FPANS 200 μg once a day (od) in maintenance and long-term treatment. Double-blind, placebo-controlled, 8-month study with three treatment periods (1-month acute period followed with 1-month maintenance period and 6-month follow-up period) was carried out. Group 1 received FPANS 200 μg bd, during acute, maintenance and follow-up periods, Group 2 received FPANS 200 μg bd during acute period and FPANS 200 μg od during maintenance and follow-up periods, and Group 3 received placebo during acute and maintenance periods and FPANS 200 μg bd during follow-up period. Endpoints were change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, intensity of symptoms and polyposis grade. After acute period and maintenance periods, FPANS 200 μg bd was significantly more effective than placebo on all endpoints and more effective than FPANS 200 μg od after 1-month maintenance period on clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell and percentage of nights with no disturbances. The two doses were similar on other endpoints. After the 6-month follow-up period, there was no difference between the two doses of FPANS at all efficacy endpoints. The safety profile of FPANS did not highlight any new or unanticipated adverse events. The study demonstrated the efficacy of FPANS 200 μg bd in acute treatment and FPANS 200 μg od as a sufficient dose to maintain a long-term efficacy in the treatment for NP.