Oral steroids and doxycycline: Two different approaches to treat nasal polyps

被引:284
作者
Van Zele, Thibaut [1 ]
Gevaert, Philippe
Holtappels, Gabriele
Beule, Achim [4 ]
Wormald, Peter John [4 ]
Mayr, Susanne [3 ]
Hens, Greet [2 ]
Hellings, Peter [2 ]
Ebbens, Fenna A. [5 ]
Fokkens, Wytske [5 ]
Van Cauwenberge, Paul
Bachert, Claus
机构
[1] Ghent Univ Hosp, Dept Otorhinolaryngol, Upper Airways Res Lab, B-9000 Ghent, Belgium
[2] Univ Hosp St Rafael, Dept Otorhinolaryngol, Louvain, Belgium
[3] Univ Erlangen Nurnberg, Dept Otorhinolaryngol Head & Neck Surg, Erlangen, Germany
[4] Univ Adelaide, Dept Surg Otorhinolaryngol, Adelaide, SA 5005, Australia
[5] Univ Amsterdam, Acad Med Ctr, Dept Otorhinolaryngol, NL-1105 AZ Amsterdam, Netherlands
关键词
Randomized controlled trial; placebo-controlled; double blind; methylprednisolone; doxycycline; Staphylococcus aureus; nasal polyposis; chronic rhinosinusitis; double-blind placebo-controlled; corticosteroids; antibiotics; QUALITY-OF-LIFE; CHRONIC SINUSITIS; MATRIX METALLOPROTEINASES; BUDESONIDE; EFFICACY; CORTICOSTEROIDS; TETRACYCLINES; INFLAMMATION; FORMULATION; CYTOKINES;
D O I
10.1016/j.jaci.2010.02.020
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: There is little scientific evidence to support the current practice of using oral glucocorticosteroids and antibiotics to treat patients with chronic rhinosinusitis and nasal polyps. Objective: We evaluated the effects of oral glucocorticoids and doxycycline on symptoms and objective clinical and biological parameters in patients with chronic rhinosinusitis and nasal polyps. Methods: In a double-blind, placebo-controlled, multicenter trial, we randomly assigned 47 participants with bilateral nasal polyps to receive either methylprednisolone in decreasing doses (32-8 mg once daily), doxycycline (200 mg on the first day, followed by 100 mg once daily), or placebo for 20 days. Participants were followed for 12 weeks. Patients were assessed for nasal peak inspiratory flow and symptoms and by nasal endoscopy. Markers of inflammation such as eosinophilic cationic protein (ECP), IL-5, myeloperoxidase, matrix metalloproteinase 9, and IgE were measured in nasal secretions. Concentrations of eosinophils, ECP, and soluble IL-5 receptor a were measured in peripheral blood samples. Results: Methylprednisolone and doxycycline each significantly decreased nasal polyp size compared with placebo. The effect of methylprednisolone was maximal at week 3 and lasted until week 8, whereas the effect of doxycycline was moderate but present for 12 weeks. Methylprednisolone significantly reduced levels of ECP, IL-5, and IgE in nasal secretions, whereas doxycycline significantly reduced levels of myeloperoxidase, ECP, and matrix metalloproteinase 9 in nasal secretions. Conclusion: This is the first double-blind, placebo-controlled study to show a significant effect of oral methylprednisolone and doxycycline on size of nasal polyps, nasal symptoms, and mucosal and systemic markers of inflammation. (J Allergy Clin Immunol 2010;125:1069-76.)
引用
收藏
页码:1069 / 1076
页数:8
相关论文
共 33 条
[1]  
Alobid I, 2006, RHINOLOGY, V44, P8
[2]   Nasal polyposis and its impact on quality of life:: comparison between the effects of medical and surgical treatments [J].
Alobid, I ;
Benítez, P ;
Bernal-Sprekelsen, M ;
Roca, J ;
Alonso, J ;
Picado, C ;
Mullol, J .
ALLERGY, 2005, 60 (04) :452-458
[3]   Nasal polyposis: From cytokines to growth [J].
Bachert, C ;
Gevaert, P ;
Holtappels, G ;
Cuvelier, C ;
van Cauwenberge, P .
AMERICAN JOURNAL OF RHINOLOGY, 2000, 14 (05) :279-290
[4]   Staphylococcus aureus superantigens and airway disease. [J].
Bachert C. ;
Gevaert P. ;
van Cauwenberge P. .
Current Allergy and Asthma Reports, 2002, 2 (3) :252-258
[5]   A short course of oral prednisone followed by intranasal budesonide is an effective treatment of severe nasal polyps [J].
Benítez, P ;
Alobid, I ;
de Haro, J ;
Berenguer, J ;
Bernal-Sprekelsen, M ;
Pujols, L ;
Picado, C ;
Mullol, J .
LARYNGOSCOPE, 2006, 116 (05) :770-775
[6]  
DEUSCHL H, 1977, Rhinology (Utrecht), V15, P17
[7]  
DINGSOR G, 1985, Rhinology (Utrecht), V23, P49
[8]  
Fokkens W, 2007, RHINOLOGY, V45, P97
[9]   Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps [J].
Gevaert, Philippe ;
Lang-Loidolt, Doris ;
Lackner, Andreas ;
Stammberger, Heinz ;
Staudinger, Heribert ;
Van Zele, Thibaut ;
Holtappels, Gabriele ;
Tavernier, Jan ;
van Cauwenberge, Paul ;
Bachert, Claus .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2006, 118 (05) :1133-1141
[10]   A novel formulation of inhaled doxycycline reduces allergen-induced inflammation, hyperresponsiveness and remodeling by matrix metalloproteinases and cytokines modulation in a mouse model of asthma [J].
Gueders, Maud M. ;
Bertholet, Pascal ;
Perin, Fabienne ;
Rocks, Natacha ;
Maree, Raphael ;
Botta, Vincent ;
Louis, Renaud ;
Foidart, Jean-Michel ;
Noel, Agnes ;
Evrard, Brigitte ;
Cataldo, Didier D. .
BIOCHEMICAL PHARMACOLOGY, 2008, 75 (02) :514-526