Corticosteroid Therapy for Chronic Rhinosinusitis Without Nasal Polyps (CRSsNP)
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Purpose
The purpose of this study is to determine the most effective route to administer steroids to patients with chronic sinusitis, specifically a type of chronic sinusitis not associated with nasal polyps (CRSsNP). The investigators would like to better understand whether orally administered steroids results in superior results when compared with nasally sprayed steroids. The investigators propose to test the hypothesis that for patients with radiographically proven CRSsNP, routine medical therapy consisting of a short course of systemic corticosteroids is superior to topical corticosteroids for relieving inflammation and the symptoms of CRS.
| Condition | Intervention | Phase |
|---|---|---|
|
Chronic Rhinosinusitis Without Nasal Polyps |
Drug: Prednisone Drug: Topical mometasone |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Role of Short Term Systemic Corticosteroid Therapy in the Management of Chronic Rhinosinusitis Without Nasal Polyps |
- Lund-McKay score from CT scan [ Time Frame: 4-6 weeks and 3 months after initiation of treatment ] [ Designated as safety issue: No ]Change from baseline in Lund-McKay scores from sinus CT-scans at 4-6 weeks and 3 months after initiation of treatment will be used to calculate the overall level of inflammation within the paranasal sinuses.
- Taskforce symptom inventory [ Time Frame: 4-6 weeks and 3 months after initiation of treatment ] [ Designated as safety issue: No ]Change from baseline in individual symptom severity. The taskforce symptom inventory is a visual analog scale of the severity of the 4 major symptoms making up the clinical diagnostic criteria of CRS.
- SNOT-22 Questionnaire [ Time Frame: 4-6 weeks and 3 months after initiation of treatment ] [ Designated as safety issue: No ]Change from baseline of the SNOT-22 score. The SNOT-22 questionnaire is a 22-item disease-specific health related quality of life instrument validated for use in chronic rhinosinusitis.
- Medication side-effect and compliance inventory [ Time Frame: 4-6 weeks and 3 months after initiation of treatment ] [ Designated as safety issue: Yes ]The medication side-effect and compliance inventory is a questionnaire to evaluate the frequency and severity of common side effects associated with the medications used in this study.
| Estimated Enrollment: | 40 |
| Study Start Date: | August 2012 |
| Estimated Study Completion Date: | February 2015 |
| Estimated Primary Completion Date: | February 2015 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Prednisone
Oral steroid medication
|
Drug: Prednisone
Three-week course of a broad-spectrum antibiotic Amoxicillin/Clavulanate at a daily dosage of 875mg twice daily If the subject is allergic to Penicillin and its derivatives or has had an adverse reaction to Amoxicillin/Clavulanate, a three-week course of clarithromycin instead Antihistamines if an appropriate history of atopy is obtained Systemic prednisone: Starting dose of 40mg for five days followed by a taper decreasing by 10mg every 5 days Following completion of the oral corticosteroid: Course of topical mometasone until the end of the study Other Names:
|
|
Active Comparator: Topical Mometasone
Topical steroid medication
|
Drug: Topical mometasone
Three-week course of a broad-spectrum antibiotic Amoxicillin/Clavulanate at a daily dosage of 875mg twice daily If the subject is allergic to Penicillin and its derivatives or has had an adverse reaction to Amoxicillin/Clavulanate, a three-week course of clarithromycin instead Antihistamines if an appropriate history of atopy is obtained Standing course of topical mometasone at the standard dose of 2 sprays to each nostril once daily and will remain on the topical mometasone until the end of the study. |
Detailed Description:
Chronic sinus infections (chronic sinusitis or CRS) are common conditions that affect millions of Americans. While this is a common disorder, medical treatments for this condition vary a lot and little is known how and why different treatments work in some individuals and not in others. Some physicians commonly utilize a course of oral steroid therapy similar to treatment of inflammatory conditions including asthma and arthritis. Other physicians feel that oral steroids are not more effective than nasal steroid sprays in reducing inflammation and prefer prescribing nasal steroids. There is no conclusive data as to whether oral or sprayed nasal steroids are more effective in providing long-term benefit to patients. Nasal steroids are FDA approved to treat some types of chronic sinusitis but oral steroids are FDA approved medications that are used to treat inflammatory conditions but is not specifically indicated for chronic sinusitis and thus should be regarded as investigational drug. The purpose of this research study is to better understand whether orally administered steroids results in superior results when compared with nasally sprayed steroids. The investigators will compare patients with chronic sinusitis who are first treated with antibiotics and oral steroids, and compare them to chronic sinusitis patients who receive antibiotics and nasally sprayed steroid therapy.
Eligibility| Ages Eligible for Study: | 18 Years to 80 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- They have three-months of persistent symptoms meeting criteria for chronic rhinosinusits as defined by the Taskforce on Rhinosinusitis.
- They have a CT-scan in our clinic or have a viewable recent (< 3weeks prior to clinic visit) CT-scan with a Lund Mckay score of 6 or greater. A Lund Mckay score of 6 or greater is felt to be indicative of at least moderate CRS.
- They do not have nasal polyps on initial clinic nasal endoscopy
- They are willing to participate in a clinical study
- They are between the ages of 18 to 80.
Exclusion Criteria:
- They have a condition in which the use of systemic corticosteroids is contraindicated such as diabetes will be excluded.
- They are unable to or unwilling to take the prescribed antibiotics or steroids will excluded.
- They have been treated with a > 3 week course of antibiotics and/or systemic steroids will also be excluded.
- They have variants of chronic sinusitis known to be refractory to medical therapy such as Wegener's granulomatosis, primary ciliary dyskinesia or sarcoidosis.
- They have sinusitis secondary to prior surgery, a dental procedure or anatomical variants.
- They have nasal polyps on physical exam.
- They are pregnant. Subjects who are possibly pregnant will be excluded based on history. Pregnancy testing is not standard of care for diagnostic imaging.
- They have a Lund-Mckay score on CT scan of < 6
- They are < 18 or > 80 years old
Contacts and Locations| Contact: Alcina Lidder | 312-695-0513 | alcinalidder@northwestern.edu |
| United States, Illinois | |
| : Northwestern Medical Faculty Foundation (NMFF) Sinus and Allergy Center | Recruiting |
| Chicago, Illinois, United States, 60611 | |
| Contact: Alcina Lidder 312-695-0513 alcinalidder@northwestern.edu | |
| Principal Investigator: Bruce Tan, MD | |
| Sub-Investigator: Robert Kern, MD | |
| Sub-Investigator: Rakesh Chandra, MD | |
| Sub-Investigator: Jill Fredona, RN | |
| Sub-Investigator: David Conley, MD | |
| Principal Investigator: | Bruce Tan, MD | Northwestern University |
More Information
Additional Information:
Publications:
| Responsible Party: | Bruce Tan, MD, Assistant Professor, Dept of Otolaryngology, Northwestern University Feinberg School of Medicine, Northwestern University |
| ClinicalTrials.gov Identifier: | NCT01676415 History of Changes |
| Other Study ID Numbers: | 18369 |
| Study First Received: | August 24, 2012 |
| Last Updated: | September 6, 2012 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Northwestern University:
|
Sinus disease Sinonasal complaints Chronic sinusitis Nasal polyps Chronic rhinosinusitis without nasal polyps |
Glucocorticoids Prednisone Topical mometasone Anti-inflammatory agents |
Additional relevant MeSH terms:
|
Nasal Polyps Polyps Sinusitis Nose Diseases Respiratory Tract Diseases Otorhinolaryngologic Diseases Pathological Conditions, Anatomical Paranasal Sinus Diseases Respiratory Tract Infections Mometasone furoate Anti-Inflammatory Agents |
Prednisone Glucocorticoids Therapeutic Uses Pharmacologic Actions Hormones Hormones, Hormone Substitutes, and Hormone Antagonists Physiological Effects of Drugs Antineoplastic Agents, Hormonal Antineoplastic Agents Anti-Allergic Agents |
ClinicalTrials.gov processed this record on May 23, 2013