Epistaxis Risk May Be Higher With Certain Intranasal Corticosteroids

Certain intranasal corticosteroids (INCS) may place patients with allergic rhinitis at a higher risk for epistaxis, according to a study published in Otolaryngology-Head and Neck Surgery.

To investigate whether the risk of epistaxis differs among INCSs, researchers conducted a systematic review to identify randomized controlled trials where the nasal sprays were used for allergic rhinitis treatment and epistaxis was reported as an adverse effect. “Meta-analyses were performed for 9 distinct INCS formulations. A risk ratio (95% CI) for epistaxis for each INCS as compared with placebo was calculated for included studies,” the authors explained.

Seventy-two studies were included in the meta-analysis; treatments evaluated included beclomethasone hydrofluoroalkane (HFA), beclomethasone aqueous, budesonide, ciclesonide HFA, ciclesonide aqueous, fluticasone furoate, fluticasone propionate, mometasone furoate, and triamcinolone. Results showed that for all INCS formulations, a relative risk for epistaxis of 1.48 (95% CI, 1.32-1.67) was observed.

Treatments associated with the greatest risk when compared with placebo were beclomethasone HFA, fluticasone furoate, mometasone furoate, and fluticasone propionate, while those with the lowest risk included beclomethasone aqueous, ciclesonide HFA, and ciclesonide aqueous. Based on these findings, the authors noted that conclusions about formulation type (aqueous vs HFA) and epistaxis risk could not be made. Moreover, a direct comparison of epistaxis risk between various INCSs was not conducted in this study.

“Further prospective cohorts comparing specific INCS formulations would better elucidate comparative epistaxis risks and safety profiles,” the authors concluded. “This would have utility in minimizing epistaxis among [allergic rhinitis] patients being treated with INCS, identifying and selecting the appropriate INCS for AR patients susceptible to epistaxis, and optimizing treatment adherence.”

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