Corticosteroid

Adverse effect

Biology

Genus

Chronic sinusitis

Surgery

Dermatology

Sinusitis

Sinus (botany)

Botany

Nose

Anesthesia

Ethmoid sinus

Immunology

Nasal polyps

Maxillary sinus

Mometasone furoate

Implant

Internal medicine

Clinical endpoint

Nasal administration

Medicine

Gastroenterology

Randomized controlled trial

Nasal congestion

International Forum of Allergy & Rhinology

Background Topical intranasal corticosteroid sprays (INCSs) are standard treatment for nasal polyps (NPs), but their efficacy is reduced by poor patient compliance and impaired access of drug to the sinus mucosa. A corticosteroid‐eluting sinus implant was designed to address these limitations in patients with recurrent polyposis after sinus surgery by delivering 1350 μg of mometasone furoate (MF) directly to the ethmoid sinus mucosa over approximately 90 days. Methods A randomized, sham‐controlled, double‐blind trial was undertaken in 300 adults with refractory chronic rhinosinusitis with NPs (CRSwNP), who were candidates for repeat surgery. Eligible patients were randomized (2:1) and underwent in‐office bilateral placement of 2 implants or a sham procedure. All patients used the MF INCS 200 μg once daily. Co‐primary efficacy endpoints were the change from baseline in nasal obstruction/congestion score and bilateral polyp grade, as determined by an independent panel based on centralized, blinded videoendoscopy review. Results Patients treated with implants experienced significant reductions in both nasal obstruction/congestion score ( p = 0.0074) and bilateral polyp grade ( p = 0.0073) compared to controls. At day 90, implants were also associated with significant reductions in 4 of 5 prespecified secondary endpoints compared to control: proportion of patients still indicated for repeat sinus surgery ( p = 0.0004), percent ethmoid sinus obstruction ( p = 0.0007), nasal obstruction/congestion ( p = 0.0248), and decreased sense of smell ( p = 0.0470), but not facial pain/pressure ( p = 0.9130). One patient experienced an implant‐related serious adverse event (epistaxis). Conclusion Significant improvements over a range of subjective and objective endpoints, including a reduction in the need for sinus surgery by 61%, suggest that MF sinus implants may play an important role in management of recurrent NP.

A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps