Is the Effect and Safety of Single Daily Dose of Fluticasone Nasal Spray Better than Alternate Day Regimen in Allergic Rhinitis?

Introduction: The goal of corticosteroid therapy is to maximize efficacy, minimize potential systemic side effects, and improve patient adherence. Factors that will potentially improve adherence to treatment and differentiate the intranasal corticosteroids are dosing regimens, patient preference and cost effectiveness. Aim and objective: To study and compare the efficacy and safety of daily versus alternate day regimen of fluticasone nasal spray. Materials and methods: A prospective, randomized comparative study was done at a tertiary care hospital which included 80 patients of symptomatic allergic rhinitis with symptoms of at least one-year duration; divided into two groups; Group A patients received once daily fluticasone furoate nasal spray for 8 weeks along with levocetirizine for 7 days. Group B patients received alternate day fluticasone furoate nasal spray for 8 weeks along with levocetirizine for 7 days. Symptoms were assessed and compared using TNS (Total nasal symptom) score at 8 weeks and after 4 weeks of stopping treatment i.e., 12 weeks after initiation of the study. Results: At 8 weeks, the mean TNS score was 0.85 ± 0.86 in Group A whereas in Group B the mean TNS score was 1.40 ± 1.08. This improvement, between both groups was statistically highly significant (p=0.007) indicating lower scores i.e., better outcome in Group A. After 4 weeks of stopping treatment i.e., 12 weeks after initiation of the study, the mean TNS score was 0.3 ± 0.42 in Group A whereas in Group B the mean TNS score was 0.45 ± 0.68. This improvement, between both groups was statistically significant (p=0.039) with marginally lower scores in Group A. Conclusion: A good subjective as well as objective outcome in terms of symptom improvement can be obtained in patients with allergic rhinitis with once daily treatment as compared to those patients who received alternate day treatment with intranasal steroids spray