Original Article

American Journal of Rhinology & Allergy

2019, Vol. 33(5) 567–576
Efficacy of Short-Term Systemic ! The Author(s) 2019
Article reuse guidelines:
Corticosteroid Therapy in Chronic sagepub.com/journals-permissions
DOI: 10.1177/1945892419851312
Rhinosinusitis With Nasal Polyps: journals.sagepub.com/home/ajr

A Meta-Analysis of Randomized Controlled

Trials and Systematic Review

Yunyun Zhang, MD1,2, Chengshuo Wang, MD, PhD1,2,

Yanran Huang, MD1,2, Hongfei Lou, MD, PhD1,2, and
Luo Zhang, MD, PhD1,2,3

Abstract
Background: Corticosteroids are considered the most effective medication to control chronic rhinosinusitis with nasal
polyps (CRSwNP); however, the studies of systemic corticosteroids in this field are relatively few and meta-analyses are lacking.
Objective: We aimed to systematically review the efficacy and safety of systemic corticosteroids for patients with CRSwNP
via meta-analysis.
Methods: Data were extracted from relevant and appropriate randomized controlled trials (RCTs) of systemic corticosteroids
for patients with CRSwNP from PubMed, MEDLINE, Ovid, Embase, the Cochrane Central Register of Controlled Trials, and
Google Scholar. Efficacy was assessed based on clinical outcomes, while safety was assessed based on adverse events (AEs).
Results: A total of 337 relevant publications were identified, of which 7 RCTs including 414 participants were included in
the meta-analysis. Compared to placebos or nonsteroid treatments, systemic corticosteroids significantly improved nasal
obstruction scores standardized mean difference (SMD
2.81; 95% confidence interval [CI],
4.68 to
0.95; P ¼.003),
reduced the nasal polyp size (SMD
4.76; 95% CI,
6.99 to
2.52; P <.0001), and improved peak nasal inspiratory flow
(PNIF) (SMD 42.39; 95% CI, 28.95 to 55.84; P <.00001). The high-dose (more than or equal to 50 mg/day prednisone) and
low-dose subgroups (less than 50 mg/day prednisone) experienced similar benefits. However, insomnia and gastrointestinal
disturbances were noted more frequently in patients treated with high doses of prednisone. Other AEs were infrequent and
were not significantly different between the subgroups.
Conclusion: Systemic corticosteroids provide significant improvements in nasal symptoms and PNIF as well as a reduction
in nasal polyp size for patients with CRSwNP. Prednisone doses less than 50 mg/day were recommended when the efficacy of
oral corticosteroids in CRSwNP was balanced against potential adverse effects.

Keywords
chronic rhinosinusitis, meta-analysis, nasal polyps, randomized controlled trials, systemic corticosteroids
Introduction
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a
chronic inflammatory disease of the nasal and paranasal
sinus mucosa for which the cause remains unclear.1
CRSwNP is often comorbid with asthma and other respi-
ratory diseases such as cystic fibrosis, primary ciliary dys-
kinesia, and aspirin intolerance triad.2–4 Nasal
obstruction and loss of smell can be troublesome, limiting
daily activities and the ability to sleep, thus reducing one’s
well-being and quality of life (Qol).5 Nasal polyps can be
1
Department of Otolaryngology Head and Neck Surgery, Beijing TongRen
Hospital, Capital Medical University, Beijing, China
2
Beijing Key Laboratory of Nasal Diseases, Beijing Institute of
Otolaryngology, Beijing, China
3
Department of Allergy, Beijing TongRen Hospital, Capital Medical
University, Beijing, China
Yunyun Zhang and Chengshuo Wang contributed equally to this work.
Corresponding Authors:
Hongfei Lou, Department of Otolaryngology Head and Neck Surgery,
Beijing Tongren Hospital, Capital Medical University, No. 1,
Dongjiaominxiang, Dongcheng District, Beijing 100730, China.
Email: louhongfei@yahoo.com
Luo Zhang, Beijing Institute of Otolaryngology, No. 17, HouGouHuTong,
DongCheng District, Beijing 100005, China.
Email: dr.luozhang@139.com
568
removed surgically or treated with steroids. Treatment
either focuses on the initial problem or preventing the
recurrence of polyps. No single surgical technique has
proven entirely curative and people often suffer from
recurrences. Systemic corticosteroids may reduce the
need for surgery, but there are concerns regarding possi-
ble side effects with long-term systemic steroid use. Thus,
the estimated clinical efficacy of systemic corticosteroids
for nasal polyposis remains unknown.
The 2012 European Position Paper on Rhinosinusitis
and Nasal Polyps (EPOS 2012)6 supports the use of a
short course of oral corticosteroids followed by topical
corticosteroids in patients with CRSwNP if the symp-
toms are severe. This is based on evidence from open
studies and 2 randomized controlled trials (RCTs).7,8
Several reviews have systematically examined topical ste-
roid use in patients with CRSwNP, highlighting
improvements in symptom scores and polyp size via
meta-analysis.9 Furthermore, a systematic review dem-
onstrated that short course corticosteroids can signifi-
cantly improve chronic rhinosinusitis without nasal
polyps symptoms.10 Similarly, high-level evidence sup-
ports the use of systemic corticosteroids, known as med-
ical polypectomy, in CRSwNP patients to improve
symptoms and polyp size.11 We, therefore, performed a
meta-analysis of RCTs to establish the effect of systemic
corticosteroid therapy in patients with CRSwNP.
Materials and Methods
Search Strategy and Selection Criteria
This systematic review and meta-analysis are reported in
accordance with the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses
(PRISMA) Statement and was registered at the
International Prospective Register of Systematic
Reviews (CRD42018105042).
A systematic search was performed for RCTs compar-
ing the effects of systemic corticosteroids with nonsteroid
treatments on symptoms in patients with CRSwNP using
the PubMed, MEDLINE, Ovid, Embase, Cochrane
Central Register of Controlled Trials, and Google
Scholar databases up to March 2018. No language restric-
tions were applied. The reference lists of all obtained
articles were examined for additional studies meeting
the inclusion criteria. Authors of published guidelines
and experts in the field were also contacted for additional
data. Medical subject heading terms, combined into the
phrases “chronic rhinosinusitis with nasal polyp” and
“systemic corticosteroids,” were used. The complete
search strategy employed for MEDLINE was a combina-
tion of the search terms “oral corticosteroids” or
“systemic corticosteroids”; “glucocorticoid,”
“corticosteroid,” “prednisolone,” “methylprednisolone,”
American Journal of Rhinology & Allergy 33(5)
“prednisone,” or “dexamethasone”; “chronic
rhinosinusitis,” “nasal polyps,” “refractory
rhinosinusitis,” or “polypsis”; and “randomized con-
trolled trial” or “randomized.” The systematic search
was not limited to a specific study or publication type in
order to ensure a thorough evaluation of the literature.
Study Selection and Data Extraction
Studies were eligible for inclusion in the meta-analysis if
they (i) involved RCTs performed in patients with
CRSwNP, (ii) compared systemic corticosteroids in
any dose and duration to other treatment strategies (pla-
cebo or nonsteroid medical treatments), and (iii)
reported changes in nasal symptom scores or clinical
outcomes between the baseline and the end of interven-
tion as well as events of adverse effects. Observational
and retrospective studies were excluded from the meta-
analysis. Steroid treatments were compared to other
treatment strategies, such as placebos and conventional
nonsteroid treatments, with no restrictions on treatment
history. Trials selected for detailed analysis and data
extraction were analyzed by 2 investigators with an
agreement value (j) of 96.5%; disagreements were
resolved by a third investigator.
Data from studies meeting inclusion/exclusion criteria
were extracted by 2 independent reviewers and cross-
checked for accuracy. The risk of bias was assessed by
2 independent reviewers in full accordance with
PRISMA recommendations.
Statistical Analysis
The reported outcomes were analyzed as either continu-
ous or dichotomous variables using Review Manager
version 5.3. For all dichotomous outcomes, including
nasal polyp changes and adverse events (AEs), relative
risk ratios and an associated 95% confidence interval
(CI) were calculated. For continuous data, including
symptom scores and clinical examinations, the mean dif-
ference was determined for studies reporting outcomes
on the same unit scale and the standardized mean dif-
ference (SMD) was used when scales differed, along with
a 95% CI.
The symptom scores, polyp scores, and peak nasal
inspiratory flow (PNIF) values were analyzed as contin-
uous variables and reported as absolute differences of
the means between the baseline and the end of the inter-
vention. Pooled estimates of the mean differences in
symptom and polyp scores between intervention
groups were measured using a random-effects model.
Pooled estimates of the mean difference in PNIF
values between intervention groups were measured
using a fixed-effects model.
Zhang et al.
Heterogeneity across study effects was assessed using
a v2 test and the I2 statistic. The I2 index describes the
percentage of variation across studies due to heteroge-
neity rather than chance. A value of 0% indicates no
observed heterogeneity and larger values indicate
increased heterogeneity. The values of P for hetero-
geneity < .05 and/or I2 > 50% denoted significant het-
erogeneity. For instances of considerable heterogeneity,
random-effects models were used instead of fixed-effects
models. Furthermore, sensitivity analyses were also per-
formed to assess heterogeneity.
Results
Study Selection and Trial Characteristics
The search strategy identified 337 unique abstracts of
which 30 met the initial screening criteria (Figure 1).
An additional 14 studies were excluded due to a lack
of randomization (n ¼ 3), lack of placebo (n ¼ 3), or
were only presented as abstracts (n ¼ 8). After reviewing
full-length articles, 4 additional studies were excluded
Figure 1. The literature search and study selection.
569
due to pooled results from 2 independent studies
(n ¼ 2) and mixed CRS cohorts (polyp and nonpolyp
patients; n ¼ 2). Twelve RCTs met all inclusion criteria
for the systematic review (Table 1); however, 5 more
RCTs were excluded for lacking quantifiable data.
Finally, 7 studies provided sufficient discrete data for a
formal meta-analysis.7,12–17
These 7 RCTs were conducted between 2001 and 2015
and comprised a total of 414 patients; sample sizes ranged
from 22 to 89 people and the trial durations spanned 7–14
days. All published articles were in English, and all par-
ticipants were over 18 years of age. The overall quality of
the RCTs was good with a low risk of bias (Figure 2).
Only articles that had adequate data available for pooled
analysis were included in the meta-analysis.
Symptom Scores
Nasal obstruction outcomes following oral corticoste-
roids were measured in 5 trials; the 5 studies comprised
a total of 280 participants. All studies demonstrated sub-
jective nasal obstruction improvements, and the overall
570
Table 1. Details of the Studies Included in the Meta-Analysis.

Delivery Total Length Meta-

Study Included Region Steroid Method Dose (days) Outcome Measure Outcome Description Analysis

1 Blomqvist et al.19 Europe Prednisolone Oral 260 10 Polyp score; nasal symptoms Nasal symptoms on the VAS (0–10) No
(Sweden) Polyp size on a scale of 0–3
2 Hissaria et al.8 Australia Prednisolone Oral 700 14 Polyp grade; nasal symptoms RSOM on a scale of 1–5 No
Polyp grade on a scale of 1–4
3 Alobid et al.14 Europe Prednisone Oral 270 14 Nasal symptoms; nasal polyp size Nasal symptoms on a scale of 0–3 Yes
(Spain) Polyp size on a scale of 0–3
4 Benitez et al.7 Europe Prednisone Oral 270 14 Nasal symptom; polyp size; Nasal symptoms on a scale of 0–3 Yes
(Spain) nasal patency Polyp size on a scale of 0–3
5 Kroflic et al.13 Europe Methylprednisolone Oral 420 7 Nasal symptom; polyp size Nasal symptoms on a scale of 0–3 Yes
(Slovenia) Polyp size on a scale of 0–3
6 Van Zele20 Europe Methylprednisolone Oral 320 21 Polyp grade; nasal symptoms Polyp grade on a scale of 0–4 No
(Belgium)
7 Vaidyanathan Europe Prednisolone Oral 350 14 Nasal polyp score; hyposmia; Polyp grade on a scale of 0–6 Yes
et al.17 (Scotland) total nasal symptom score; PNIF Hyposmia VAS (0–100)
8 Kirtsreesakul Asia Prednisolone Oral 700 14 Nasal symptoms; nasal polyp size Ranked symptom severity No
et al.18 (Thailand) on a scale of 0–6
9 Kirtsreesakul21 Asia Prednisolone Oral 700 14 Nasal symptoms; nasal polyp size Ranked symptom severity No
(Thailand) on a scale of 0–6
10 Alobid et al.15 Europe Prednisolone Oral 270 14 Nasal congestion; PNIF, Ranked symptom severity Yes
(Spain) CT scan score on a scale of 0–3
11 Alobid et al.16 Europe Prednisolone Oral 270 14 Nasal congestion; polyp size Ranked symptom severity Yes
(Spain) on a scale of 0–3
12 Ecevit et al.12 Europe Prednisolone Oral 720 14 Nasal symptom; polyp size; PNIF Nasal symptoms Yes
(Turkey) on the VAS (0–10)
Polyp size on a scale of 0–3, PNIF
Abbreviations: CT, computed tomography; PNIF, peak nasal inspiratory flow; RSOM, rhinosinusitis outcome measure; VAS, visual analog scale.
Zhang et al.
SMD was
2.81 (95% CI,
4.68 to
0.95) (Figure 3
(A)). Nasal obstruction improvements favored oral cor-
ticosteroids over nonsteroid treatments (P ¼ .003). The
remaining 2 studies that assessed nasal obstructions
Figure 2. A risk of bias graph depicting the quality assessment of
the trials included in the meta-analysis.
Figure 3. A pooled analysis of all RCTs using oral corticosteroids with reported nasal obstruction (A) and loss of smell (B) outcomes. A
negative SMD in this analysis favors the experimental group because the decrease in the nasal symptom scores signifies improvement. CI,
confidence interval; I2, the variation in the risk ratio attributable to study heterogeneity; RCT, randomized clinical trial; SD, standard
deviation; SMD, standardized mean difference.
571
following systemic corticosteroid use did not have orig-
inal data for meta-analysis.
Besides nasal obstruction, the loss of smell was anoth-
er main complaint in nasal polyp patients. Olfactory out-
comes were measured by 7 studies in which 5
demonstrated significant improvements; the SMD of
the pooled studies was
1.93 (95% CI,
3.35 to

0.51) (Figure 3(B)). Olfactory outcome improvements
favored oral corticosteroids over nonsteroid treatments
(P ¼ .008). The other 2 studies showed statistically sig-
nificant improvements in olfactory outcomes after sys-
temic corticosteroid treatment compared to placebos
(P < .05); however, there were no sufficient original
data to include in the meta-analysis.
Nasal Polyp Scores
Nasal polyp score, an objective outcome, was measured
by 7 trials using either the Lildholdt classification (scores
from 0 to 3)7,12–16 or endoscopic polyp grading (scores
from 0 to 6 scores).17 Six studies (n ¼ 360 participants)
described polyp size with nasal polyp scores, 5 of which
used the Lildholdt classification and 1 used endoscopic
polyp grading; meanwhile, the remaining study
described changes in polyp size by percentage, not orig-
inal scores. The quantitative analysis demonstrated sig-
nificant improvements and the SMD of the pooled
studies was
4.76 (95% CI,
6.99 to
2.52)
(P < .0001) (Figure 4). The results showed a reduction
in polyp sizes favoring systemic corticosteroids com-
pared to controls.
572 American Journal of Rhinology & Allergy 33(5)

Figure 4. Quantitative data and a forest plot of the total nasal polyp scores of eligible studies comparing systemic corticosteroid use with
controls. The SMD was
4.76 (95% CI,
6.99 to
2.52). The negative SMD in this analysis favors the experimental group because the
decrease in the nasal polyp score indicates improvement. CI, confidence interval; I2, the variation in the risk ratio attributable to study
heterogeneity; SD, standard deviation; SMD, standardized mean difference.

Figure 5. Quantitative data and a forest plot of the total PNIF of eligible studies comparing systemic corticosteroids with controls. The
mean difference was 42.39 (95% CI, 28.95–55.84). CI, confidence interval; I2, the variation in the risk ratio attributable to study het-
erogeneity; PNIF, peak nasal inspiratory flow; SD, standard deviation.

PNIF Outcome Table 2. Influence of Excluding Each Individual Study One at a

Time on the Meta-Analysis.
Three studies (n ¼ 142 participants) assessed PNIF
Study Omitted SMD 95% CI I2 (%) P
changes after treatment; all demonstrated significant
improvements. The mean difference of the pooled stud- Nasal obstruction
ies was 42.39 (95% CI, 28.95–55.84) (Figure 5). PNIF Alobid et al.14
1.22%
2.04 to
0.40 82 .004
Alobid et al.15
3.18
5.76 to
0.60 97 .02
improvements favored oral corticosteroids compared to Alobid et al.16
3.25
5.93 to
0.57 97 .02
controls (P < .00001). Ecevit et al.12
3.08
5.35 to
0.81 97 .008
Although heterogeneity was seen across studies, the Kroflic et al.13
3.56
5.86 to
1.26 97 .002
systemic steroid treatment had an overwhelming positive Loss of smell
Alobid et al.14
0.99
1.47 to
0.50 54 <.0001
effect on patient symptomatology and nasal polyp
Alobid et al.15
2.02
3.92 to
0.12 96 .04
scores. The robustness of the overall effect of any Ecevit et al.12
2.17
3.92 to
0.43 96 .01
single study was evaluated by removing each study one Kroflic et al.13
2.30
4.11 to
0.50 96 .01
at a time (Table 2). No study was found to qualitatively Vaidyanathan et al.17
2.24
4.17 to
0.30 96 .02
Nasal polyp score
change the pooled findings in the symptoms or polyp
Alobid et al.14
2.99
4.81 to
1.16 97 .001
size outcomes. Alobid et al.16
5.92
9.02 to
2.83 98 .0002
Benitez et al.7
5.87
8.99 to
2.76 98 .0002
Adverse Events Ecevot et al.12
5.74
8.45 to
3.03 98 <.0001
Kroflic et al.13
6.07
8.85 to
3.29 98 <.0001
Of the 12 RCT studies, 4 described the details of AEs Vaidyanathan et al.17
2.55
4.39 to
0.71 97 .006
without serious adverse effects, such as peptic ulcers and
Abbreviations: CI, confidence interval; I2, variation in the risk ratio attrib-
osteonecrosis of the femoral head. Hissaria et al.8 utable to study heterogeneity; SMD, standardized mean difference.
and Kirtsreesakul et al.18 (both studies had a dose of
50 mg/day prednisone) reported that insomnia, gastro-
intestinal disturbances, and dyspepsia were noted more other 2 studies (with a prednisone dose less than 50 mg/
frequently in participants being treated with prednisone day).17,18 Subsequently, we performed a subgroup anal-
(P < .05). However, there were no significant differences ysis based on the prednisone dose to evaluate
in AEs between the prednisone and control groups in the the efficacy.
Zhang et al. 573

Figure 6. Quantitative data and forest plots of the subgroup analysis of symptom outcomes based on the prednisone dose. (A) Nasal
obstruction data. In the high-dose subgroup, SMD ¼
1.87 (95% CI,
2.91 to
0.83; P ¼.0004); in the low-dose subgroup, SMD ¼
4.18
(95% CI,
7.27 to
1.08; P ¼.008). (B) Loss of smell data. In the high-dose subgroup, SMD ¼
0.99 (95% CI,
1.89 to
0.09; P ¼.003). In
low-dose subgroup, SMD ¼
2.85 (95% CI,
5.14 to
0.56; P ¼.01). SD, standard deviation; SMD, standardized mean difference; CI,
confidence interval.

Subgroup Analysis of High and Low Doses of
Systemic Steroids
One study with at least 50 mg/day prednisone (high
dose) and 3 studies with less than 50 mg/day (low
dose) were examined in the subgroup analysis. There
was a significant difference in favor of the high-dose
(SMD
1.87; 95% CI,
2.91 to
0.83; P ¼ .0004;
Figure 6(A)) and low-dose subgroups (SMD
4.18;
95% CI,
7.27 to
1.08; P ¼ .008; Figure 6(A)), com-
pared to placebos, with respect to nasal obstruction.
There was no significant difference between the 2 sub-
groups (P ¼ .17).
We also evaluated the effect on olfactory function
among subgroups. There was a significant benefit in
both subgroups (SMD
0.99; 95% CI,
1.89 to

0.09; P ¼ .003 in the high-dose subgroup;
SMD
2.85; 95% CI,
5.14 to
0.56; P ¼ .01 in the
low-dose subgroup) (Figure 6(B)). Similarly, there
was no significant difference between the 2 sub-
groups (P ¼ .14).
We also assessed nasal polyp scores as the objective
outcome. Two studies with high doses and 4 studies with
low doses were recruited in the subgroup analysis of
nasal polyp scores. There was a significant improvement
in the high-dose (SMD
0.50; 95% CI,
0.93 to 0.07;
P ¼ .02; Figure 7) and low-dose subgroups (SMD
1.16;
95% CI,
1.87 to
0.46; P ¼ .001; Figure 7) in the nasal
polyp scores, superior to placebos. Meanwhile, there was
no significant difference between the 2 sub-
groups (P ¼ .11).
Discussion
The management of nasal polyps can be challenging and
often requires long-term medical treatment to control
nasal symptoms. Corticosteroids are frequently
employed to treat CRS due to their potent anti-
inflammatory effects. Intranasal corticosteroids are con-
sidered the first choice for nasal polyp treatment.
Correspondingly, the EPOS 20126 also indicated that
574
Figure 7. Quantitative data and a forest plot of the subgroup analysis of nasal polyp scores based on the prednisone dose. In the high-
dose subgroup, SMD ¼
0.50 (95% CI,
0.93 to 0.07; P ¼.02). In the low-dose subgroup, SMD ¼
1.16 (95% CI,
1.87 to
0.46;
P ¼.001). SD, standard deviation; SMD, standardized mean difference; CI, confidence interval.
short-term oral corticosteroids can be used to control
symptoms in patients with severe nasal polyps. Three
studies7,15,16 using oral corticosteroids following intrana-
sal corticosteroids showed sustained benefits in nasal
polyp management. A systematic review22 reported
that more thorough, well-designed, prospective, RCTs
are still needed to address oral steroid use for
CRSwNP. Our meta-analysis validates the efficacy of
systemic corticosteroid therapy in patients with nasal
polyps with subjective and objective clinical outcomes.
These findings showed similar olfactory function
improvements as the meta-analysis by Banglawala
et al.23Consistent with the other studies,10,19,24,25 we
found that systemic corticosteroids improved nasal
obstructions and reduced polyp size. In this regard,
Head et al.26 showed comparable data in a review with-
out a quantitative meta-analysis. Poetker et al.27 evalu-
ated steroid use and strongly recommended oral steroids
for CRSwNP, which was consistent with our meta-
analysis results. Moreover, our meta-analysis first
demonstrated PNIF improvements after systemic corti-
costeroid treatment, coinciding with advances in symp-
tom control and nasal polyp reduction. Also, the
robustness of the overall effect of a single study provided
strong evidence to support our results.
The benefits of systemic steroids are time limited due
to the side effects.6 Therefore, the efficacy of oral corti-
costeroids in CRSwNP must be carefully balanced
against potential adverse effects. Vaidyanathan et al.17
reported safety outcomes, including basal and dynamic
adrenal function, and observed markers of osteoblast
activity. Adrenal function was suppressed by oral pred-
nisolone but recovered after 10 weeks. No serious AEs,
such as osteonecrosis of the femoral head, were reported.
Hissaria et al.8 included an AEs analysis in their study
American Journal of Rhinology & Allergy 33(5)
that revealed an increase in AEs in the oral steroids
group, compared to placebos, after a 50 mg/day predni-
sone treatment for 14 days for insomnia. Similarly, dys-
pepsia and gastrointestinal disturbances were noted
more frequently in patients with the same treatment.18
However, no patients reported significant adverse symp-
toms during the days immediately after prednisolone
cessation. In our review, 50 mg/day prednisone for
14 days led to more frequent AEs in the experimental
group. The subgroup analysis revealed that a prednisone
dose of at least 50 mg/day did not offer better
efficacy when compared a lower dose. Therefore, a pred-
nisone dose of less than 50 mg/day is recommended,
considering the lower risk of AEs. Nevertheless, this rec-
ommendation should be tested with more studies in
the future.
A limitation of this analysis is that there was signifi-
cant variability in the duration (range: 7–21 days) and
total dose (range: 270–720 mg) of systemic corticoste-
roids in the intervention group. Thus, there was no uni-
versal protocol of systemic corticosteroids for CRSwNP.
Furthermore, we cannot define the correlation between
dose and efficacy. Another limitation is the lack of a
long-term follow-up for systemic corticosteroid therapy,
negating a quantitative pooled analysis. Also, only 2
studies utilized a validated Qol instrument as the prima-
ry outcome measure, so we could not evaluate Qol via
meta-analysis. Finally, instead of nasal obstruction and
loss of smell, other common symptoms of CRSwNP
including facial pain and rhinorrhea, which did not
have enough quantitative data in the 12 RCT studies,
were excluded from the meta-analysis. Interestingly,
most of the studies in our review originated in Europe
(10/12); this could decrease the external validity and gen-
eralizability to other patient populations.
Zhang et al.
Conclusion
This meta-analysis confirmed that short-term systemic
corticosteroid use significantly improved nasal symp-
toms, reduced nasal polyp size, and increased PNIF in
patients with CRSwNP. Although optimal systemic
corticosteroid treatment strategies have not been
established in practice, our findings strongly support
short-term use of systemic corticosteroids in the clinical
management of patients with CRSwNP. Furthermore,
the efficacy should be balanced against safety during
and after the treatment.
Authors’ Contribution
Y. Z., C. W., and Y. H. contributed to the acquisition of data.
H. L. and L. Z. provided input to the study design and partic-
ipant recruitment. H.L. and L.Z. contributed in this work. All
authors were responsible for preparation of the manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of
this article
Funding
The author(s) disclosed receipt of the following financial sup-
port for the research, authorship, and/or publication of this
article: This work was supported by grants from the
National Natural Science Foundation of China (81630023,
81420108009, 81400444, and 81470678), the National Key
R&D program of China (2016YFC20160905200), the
Program for Changjiang Scholars and Innovative Research
Team (IRT13082), Beijing Municipal Administration of
Hospitals’ Mission Plan (SML20150203), Beijing Municipal
Administration of Hospitals’ Youth Programme
(QML20150202), and the Beijing Advanced Innovation
Center for Food Nutrition and Human Health (Beijing
Technology and Business University 20181045).
ORCID iD
Luo Zhang https://orcid.org/0000-0002-0910-9884
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