A Cochrane review [withdrawn from publication] included 40 studies with a total of 3624 patients with chronic rhinosinusitis and nasal polyps. In 26 studies (65%) all or the majority of participants had sinus surgery. The primary outcomes were sino-nasal symptoms, polyp size and polyp recurrence after surgery. When compared to placebo, topical corticosteroids improved overall symptom scores (SMD -0.46; 95% CI -0.65 to -0.27; 7 trials, n = 445) and had a higher proportion of responders (RR 1.71; 95% CI 1.29 to 2.26; 4 trials, n = 234). Topical corticosteroids also decreased the polyp score (SMD -0.73; 95% CI -1.00 to -0.46; 3 trials, n = 237) and had a greater proportion of patients with a reduction in polyp size (RR 2.09; 95% CI 1.65 to 2.64; 8 trials, n = 785) when compared to placebo. Topical corticosteroids also prevented polyp recurrence after surgery (RR 0.59; 95% CI 0.45 to 0.79; 6 trials, n = 437). Subgroup analyses by sinus surgery status revealed a greater benefit in reduction of polyp score when topical steroid was administered any time after sinus surgery (SMD -1.19; 95% CI -1.54 to -0.83; 2 studies, n=144) compared to patients who had never had surgery (SMD -0.13; 95% CI -0.53 to 0.28, p < 0.00001; 1 study, n=93). There was no difference between groups in terms of adverse events.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).
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