Meta-Analysis of Azelastine Nasal Spray for the Treatment of Allergic Rhinitis
Midwest Center for Health Services and Policy Research, Hines Veterans Affairs Hospital, Hines, Illinois, USA. Pharmacotherapy
(Impact Factor: 2.66).
07/2007; 27(6):852-9. DOI: 10.1592/phco.27.6.852
To systematically review the efficacy of azelastine nasal spray for the treatment of allergic rhinitis.
Meta-analysis of published randomized controlled trials reported in English.
Published literature from the PubMed-MEDLINE database.
Patients aged at least 12 (United States) or 16 years (Europe) with allergic rhinitis or nonallergic vasomotor rhinitis.
A global assessment of efficacy was used to estimate the number needed to treat for azelastine nasal spray compared with placebo or active comparators. The total symptom score was used to compare the effect size between azelastine and placebo. In five comparisons of azelastine and placebo, azelastine was most efficacious, with a summary number needed to treat of 5.0 (95% confidence interval [CI] 3.3-10.0). In reviewing 11 studies of azelastine versus active comparators, we found no significant difference between azelastine and active comparators (number needed to treat 66.7, 95% CI 14.3 to infinity to 25). Azelastine was more efficacious than placebo in terms of total symptom score (effect size of 0.36, 95% CI 0.26-0.46).
Azelastine nasal spray was more efficacious than placebo in the treatment of allergic rhinitis. No significant differences were observed between azelastine and active comparators for the treatment of allergic rhinitis; however, when azelastine was compared with oral antihistamines as monotherapy, the trend favored azelastine. Because azelastine appears to be as efficacious as oral antihistamines, the choice of treatment for seasonal allergic rhinitis should depend on the patient's preference regarding the route of administration, adverse effects, and the cost of the drug.
Available from: Ellis Kam Lun Hon
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ABSTRACT: Seasonal allergic rhinitis is characterized by seasonal rhinorrhea, nasal congestion/stuffiness, nasal and ocular pruritus, and paroxysmal sneezing. Symptomatic relief and improved quality of life can be achieved in the majority of patients by using pharmacotherapy appropriately. Mild cases can be managed with either an oral antihistamine or a nasal corticosteroid alone. More severe cases may require a nasal corticosteroid in combination with various agents. Immunotherapy is reserved for a selected group of patients. While all other interventions provide symptomatic relief, specific immunotherapy may have long-term effects. This review article also discuss recent patents related to the field.
Recent Patents on Inflammation & Allergy Drug Discovery 02/2008; 2(3):175-85. DOI:10.2174/1872213X113079990022
Available from: PubMed Central
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ABSTRACT: Azelastine nasal spray (Allergodil((R)), Lastin((R)), Afluon((R)); Meda AB, Stockholm, Sweden) is a fast-acting, efficacious and well-tolerated H1-receptor antagonist for the treatment of rhinitis. In addition it also has mast-cell stabilizing and anti-inflammatory properties, reducing the concentration of leukotrienes, kinins and platelet activating factor in vitro and in vivo, as well as inflammatory cell migration in rhinitis patients. Well-controlled studies in patients with seasonal allergic rhinitis (SAR), perennial rhinitis (PR) or vasomotor rhinitis (VMR) confirm that azelastine nasal spray has a rapid onset of action, and improves nasal symptoms associated with rhinitis such as nasal congestion and post-nasal drip. Azelastine nasal spray is effective at the lower dose of 1 spray as well at a dose of 2 sprays per nostril twice daily, but with an improved tolerability profile compared to the 2-spray per nostril twice daily regimen. Compared with intranasal corticosteroids, azelastine nasal spray has a faster onset of action and a better safety profile, showing at least comparable efficacy with fluticasone propionate (Flonase((R)); GSK, USA), and a superior efficacy to mometasone furoate (Nasonex((R)); Schering Plough, USA). In combination with fluticasone propionate, azelastine nasal spray exhibits greater efficacy than either agent used alone, and this combination may provide benefit for patients with difficult to treat seasonal allergic rhinitis. In addition, azelastine nasal spray can be used on an as-needed basis without compromising clinical efficacy. Compared with oral antihistamines, azelastine nasal spray also demonstrates superior efficacy and a more rapid onset of action, and is effective even in patients who did not respond to previous oral antihistamine therapy. Unlike most oral antihistamines, azelastine nasal spray is effective in alleviating nasal congestion, a particularly bothersome symptom for rhinitis sufferers. Azelastine nasal spray is well tolerated in both adults and children with allergic rhinitis. Bitter taste which seems to be associated with incorrect dosing technique is the most common side effect reported by patients, but this problem can be minimized by correct dosing technique.
Therapeutics and Clinical Risk Management 11/2008; 4(5):1009-22. · 1.47 Impact Factor
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ABSTRACT: To review the literature supporting current recommendations for nasal antihistamines as first-line therapy for allergic rhinitis.
Published articles in the peer-reviewed medical literature.
Clinical trials focusing on the efficacy, safety, and recommended uses of the currently approved nasal antihistamines in the United States: azelastine nasal spray, 0.1%, and olopatadine nasal spray, 0.6%.
Azelastine nasal spray, 0.1%, and olopatadine nasal spray, 0.6%, have rapid onsets of action, are well tolerated, and have clinical efficacy for treating allergic rhinitis that is equal or superior to oral second-generation antihistamines. Both also have a clinically significant effect on nasal congestion. Azelastine is also approved for nonallergic rhinitis. Although older data suggest that intranasal steroids have greater clinical efficacy than nasal antihistamines, more recent comparisons in patients with mild to moderate disease have shown equal or noninferior efficacy. In addition, in contrast to oral antihistamines or leukotriene antagonists, the combination of a nasal antihistamine and intranasal steroid may provide additive benefits for treating patients with more severe disease.
The data support current recommendations for nasal antihistamines as first-line therapy for allergic rhinitis. Future studies should address possible as needed use, the use of premixed antihistamine-steroid combinations, and the treatment of mixed rhinitis.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 11/2009; 103(5):373-80. DOI:10.1016/S1081-1206(10)60355-9 · 2.60 Impact Factor
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