Prescription Profile and Clinical Outcomes in Patients with Allergic Rhinitis Treated with Oral Antihistamines or Nasal Corticosteroids

THIEME Original Research Prescription Profile and Clinical Outcomes in Patients with Allergic Rhinitis Treated with Oral Antihistamines or Nasal Corticosteroids Guillermo Sánchez1,2 Carlos Castro1,2 1 Department of Research, Soluciones Integrales para la Investigación y la Educación en Salud (SIIES), Bogotá, Colombia 2 Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia Address for correspondence Guillermo Sánchez, MD, MSc, PhD, Departamento de Investigación, Soluciones Integrales para la Investigación y la Educación en Salud (SIIES), Calle 106 # 54-15. Oficina: 602, Bogotá, Colombia (e-mail: ; ). Int Arch Otorhinolaryngol 2019;23:325–330. Abstract Keywords ► perennial allergic rhinitis ► histamine antagonists ► mometasone furoate ► ciclesonide ► drug prescriptions ► cohort studies Introduction Oral antihistamines and intranasal corticosteroids have been shown to be effective and safe for the treatment of allergic rhinitis; however, the evidence suggests a level of superiority of corticosteroids, so they should be preferred over the former. Objective To know the prescription profile of two second generation antihistamines (cetirizine and levocetirizine) and two nasal corticosteroids (mometasone and furoateciclesonide) in a cohort of patients with allergic rhinitis, and to compare the clinical outcomes obtained. Methods A cohort study was carried including patients with allergic rhinitis treated with cetirizine, levocetirizine, mometasone furoate or ciclesonide. The improvement was evaluated with the total nasal symptoms score (TNSS). This scale yields results between 0 and 12. Zero indicates absence of symptoms. Results A total of 314 patients completed 12 weeks of follow-up. Seventy-five percent were treated with antihistamines, 20% with corticosteroids, and 5% with a combination of the above. The TNSS median for corticosteroid was 2.5 points; for antihistamines, its was 5 points, and for combination, it was 4 points. We found differences between corticosteroids and antihistamines. Conclusion The prescription percentage of second generation oral antihistamines is higher than that of intranasal corticosteroids. However, patients with allergic rhinitis treated with the second option obtained better control of symptoms. Introduction Allergic rhinitis is a symptomatic disorder whose main effect occurs on the nasal mucosa. This effect is induced by exposure to allergens, which trigger an inflammatory process mediated by immunoglobulin-E (Ig-E).1 This condition is relatively frequent and has a high prevalence between 13 Guillermo Sánchez's ORCID is https://orcid.org/0000-0002-49547803. received December 27, 2017 accepted April 13, 2019 DOI https://doi.org/ 10.1055/s-0039-1688968. ISSN 1809-9777. and 14 years of age, a group in which it can reach 14.6%. According to the data reported by the International Study of Asthma and Allergies in Childhood (ISAAC).2 From a global perspective, Africa and Latin America have the highest reported prevalence (18% and 17.3% respectively), and Colombia ranks 5th worldwide, reaching a percentage of 25.2% of cases in the adolescent population.2 Due to the high burden of the disease, the volume of consultations generated by this condition is understandable, with examples such as the one reported by the national ambulatory care survey Copyright © 2019 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 325 326 Prescription Profile and Clinical Outcomes Sánchez et al. conducted in the United States between 1995 and 1998, in which rhinitis represented almost 3% of the total of family physicians’ consultations, and it was located in the 12th position of frequent consultation reasons.3 The symptoms associated with this pathology, such as rhinorrhea, lacrimation, conjunctival injection, pruritus and nasal obstruction, significantly affect the quality of life, and social and work performances, which is why it is essential to offer the patient safe and effective therapeutic alternatives to keep them free of symptoms most of the day, preventing their onset or quickly controlling the symptoms.4,5 Within the therapeutic arsenal, there are multiple options, among which are oral and topical antihistamines, leukotriene inhibitors, intranasal decongestants and topical intranasal corticosteroids. Faced with all these alternatives, there is evidence in the scientific literature that suggests that treatment with second-generation antihistamines or intranasal aerosol corticosteroids are the first-choice option in all cases; however, when these two therapies are compared, the recommendation is aimed at preferring intranasal corticosteroids over antihistamines.4,6 Specifically, within the group of intranasal corticosteroids, it is worth highlighting mometasone furoate, which is a synthetic glucocorticoid, capable of inhibiting the formation, release, and activation of chemical and cellular mediators that facilitate the control and prevent the appearance of new episodes. This medication was introduced to the world market in 1998 and has been used with a high safety profile and effectiveness over many years.7 In Colombia, this drug proved to be a cost-effective strategy compared with beclomethasone dipropionate.8 Despite the recommendation to prefer intranasal corticosteroids over antihistamines,4,6 researchers have hypothesized that the treatment of this condition in the country is based mainly on the use of antihistamines, probably related to a low level of access to specialists in otorhinolaryngology, and due to the high availability of over-the-counter antihistamines at a low cost, compared with nasal corticosteroids. Despite this perception, it was not possible to document in the national literature studies that allowed establishing the distribution of the prescription or use of this type of medication in patients with allergic rhinitis. Considering the above, the aim of this study was to know the prescription profile of two second-generation antihistamines (cetirizine, levocetirizine) and two nasal corticosteroids (mometasone, furoate-ciclesonide), and to compare the clinical outcomes after a 12-week follow-up of a Colombian patient’s cohort with allergic rhinitis treated by a group of general practitioners. Methods Design An observational cohort analytical study was performed, within the framework of the activities of a follow-up program to monitor adverse events, clinical outcomes and profiles of use of a group of drugs from the Abbott laboratory portfolio, called the Biomedical Monitoring Registry of medInternational Archives of Otorhinolaryngology Vol. 23 No. 3/2019 ical care and clinical outcomes in frequent pathologies (RBDC). This project complied with all the national and international research ethics regulations and was approved by an independent ethics committee. Population and Sample Within the program Registro biomédico de desenlaces clínicos (RBDC, in the spanish acronym), through a sequential sampling, pa (...truncated)