title: Examining the safety of prednisolone acetate 1% nasal spray for treatment of nasal polyposis.
abstract: BACKGROUND
  Topical intranasal corticosteroid sprays are a mainstay of treatment for nasal polyposis. Newer treatment strategies for refractory polypoid disease include "off label" topical steroids such as prednisolone acetate. This study investigates the safety of intranasal prednisolone acetate; evaluating its effect on serum cortisol and adrenocorticotropin hormone (ACTH) levels.
  
  
  METHODS
  This retrospective study included adult patients with refractory nasal polyposis, who had not taken oral steroids for 3 months prior to entry into the study. Patients applied 2 sprays of 1% prednisolone acetate delivered via a 15-mL standardized spray bottle twice daily. Morning serum cortisol and ACTH levels were collected prior to treatment and 6 to 8 weeks posttreatment. Pretreatment and posttreatment values were compared.
  
  
  RESULTS
  Nine patients were included in this study. The average serum cortisol and ACTH levels prior to treatment was 12.09 μg/dL (95% confidence interval [CI], 6.94-17.24) and 12.33 ng/L (95% CI, 8.97-15.70), respectively. After 6 to 8 weeks of treatment, the average serum cortisol and ACTH levels were 11.76 μg/dL (95% CI, 9.51-14.00) and 13.22 ng/L (95% CI, 10.68-15.77), respectively. There was no statistically significant difference between pretreatment and posttreatment values for cortisol (p = 0.89) or ACTH (p = 0.63).
  
  
  CONCLUSIONS
  Intranasal delivery of prednisolone acetate, at the specified dose, does not result in suppression of the adrenal axis. It can be considered as a safe alternative for management of aggressive nasal polyposis refractory to traditional treatment strategies.
authors.affiliation: Department of Otolaryngology, University of California Davis, Sacramento, CA 95817, USA. Jonathan.liang@ucdmc.ucdavis.edu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Liang
authors.forename: E Bradley
authors.initials: EB
authors.lastname: Strong
mesh_terms: D000281:Administration, Intranasal; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000097:blood / Q000188:drug therapy*; D059085:Nasal Sprays; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D059085:Nasal Sprays; C009935:prednisolone acetate; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D006854:Hydrocortisone