Effect of systemic steroids on long-term post-operative sinonasal and general quality of life and inflammatory biomarkers: A randomized placebo controlled clinical trial

Objective The objective of this study was to determine whether post-operative systemic steroid administration in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) impacted 1) the Nasal Polyp and Lund-Kennedy Score 2) recurrence rates 3) long-term sinonasal and general quality of life (SNQOL, GQOL) 4) mucus derived biomarker levels and 5) smell scores and whether risk of recurrence could be predicted using preoperative SNQOL, GQOL, and selected biomarkers.

Methods Prospective randomized placebo controlled trial of n=61 patient with CRSwNP (2005-2019). All patients underwent FESS followed by randomization to a systemic steroid (n=33) or placebo group (n=28) for 1 month. All subjects used topical nasal steroids for 3 months. Patients were followed for 2 years at 10 time points when sinonasal symptoms, SF-36 and RSDI scores were assessed. Mucus biomarker levels were also analysed at each time point.

Results Post-operative systemic steroids were non-superior to placebo with respect to all outcome measures at the 1-year and 2-year follow-up (p>0.05 for all) and had no impact on recurrence rates. Recurrences within 2 years could be predicted by a preoperative SNOT-22 d1 score of >19 and RSDI >96 (Sensitivity 0.80 and 1.0; p < 0.01 for both).

Conclusions The addition of post-operative systemic steroids did not confer a benefit over topical steroid nasal spray alone with respect to SNQOL and GQOL over 2 years. Simultaneously, the addition of post-operative systemic steroids had no impact on recurrence rates. Preoperative cut-off values of the SNOT-22 domain 1 and the RSDI may be able to predict early recurrences.

Poster-PDF A-1605.pdf

Conflict of interest

Der Erstautor gibt keinen Interessenskonflikt an.

Publication History

Article published online:
13 May 2021