title: Efficacy and systemic tolerability of mometasone furoate and betamethasone sodium phosphate.
abstract: This study evaluates the efficacy and systemic tolerability of licensed doses of mometasone furoate (Nasonex) and betamethasone sodium phosphate (Betnesol) in allergic chronic rhinosinusitis patients. It also assesses the diagnostic accuracy of morning salivary cortisol (MSC) concentrations to screen for adrenal suppression in these patients. Forty-eight patients were prospectively randomized to two treatment limbs. Symptom scores and adrenal function assessments were performed immediately prior to commencement and at the end of treatment. One (4 per cent) mometasone furoate and 14 (58 per cent) betamethasone sodium phosphate patients developed biochemical evidence of adrenal suppression. There were statistically significant (p < 0.005) reductions in symptom scores following treatment, but no significant difference (p > 0.05) between the drug groups regarding post-treatment symptom scores. As a screening tool for iatrogenic adrenal suppression, MSC had a sensitivity of 100 per cent and a specificity of 97 per cent. This study demonstrates the high risk of developing adrenal suppression secondary to betamethasone sodium phosphate therapy. The salivary cortisol assay is an accurate tool for monitoring adrenal function and is ideally suited to the out-patient setting.
authors.affiliation: Departments of Otolaryngology, North Glasgow Hospitals University NHS Trust, UK. dr_rajan_patel@hotmail.com
authors.forename: Rajan S
authors.initials: RS
authors.lastname: Patel
authors.forename: Steve R
authors.initials: SR
authors.lastname: Shaw
authors.forename: A Michael
authors.initials: AM
authors.lastname: Wallace
authors.forename: Gerald W
authors.initials: GW
authors.lastname: McGarry
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000139:chemically induced / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D018926:Anti-Allergic Agents / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001623:Betamethasone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood; D008297:Male; D008875:Middle Aged; D000068656:Mometasone Furoate; D011244:Pregnadienediols / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy*; D012463:Saliva / Q000737:chemistry; D012680:Sensitivity and Specificity; D012852:Sinusitis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D018926:Anti-Allergic Agents; D000893:Anti-Inflammatory Agents; D011244:Pregnadienediols; D000068656:Mometasone Furoate; C028994:betamethasone sodium phosphate; D001623:Betamethasone; D006854:Hydrocortisone