Clinical Question: Are oral steroids effective in the management of nasal polyps?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: The investigators identified 41 adults, 18 to 64 years of age, with symptomatic polyp disease diagnosed by nasendoscopy. Patients randomly received (concealed allocation) prednisolone (Orapred; 50 mg) or matched placebo once daily for 14 days. Individuals assessing outcomes remained blinded to treatment group assignment. Follow-up occurred for more than 97 percent of patients for 14 days. Subscores from a cluster of six nasal symptoms (i.e., congestion, rhinorrhea, sneezing, hyposmia, postnasal discharge, and thick nasal debris), derived from a 31-item questionnaire assessing rhinosinusitis outcomes, were reported at baseline and after two weeks of therapy.

Using intention-to-treat analysis, a clinically significant (greater than 20 percent) improvement in scores occurred in 95 percent of prednisolone-treated patients, compared with 37 percent in the placebo group (number needed to treat = 2; 95% confidence interval, 1 to 3). Polyp size as assessed by nasendoscopy also was significantly reduced. Insomnia occurred significantly more often in the prednisolone group, but other side effects were infrequent and not different between the treatment groups.

Bottom Line: Fourteen days of oral prednisolone (50 mg daily) significantly improves nasal function scores and reduces polyp size. The duration of this benefit, however, is not clear. (Level of Evidence: 1b)