title: Does oral prednisolone increase the efficacy of subsequent nasal steroids in treating nasal polyposis?
abstract: BACKGROUND
  Although combined oral and nasal steroid therapy is widely used in nasal polyposis, a subset of patients show an unfavorable therapeutic outcome. This study aimed to evaluate whether oral prednisolone produces any additive effects on subsequent nasal steroid therapy  and to evaluate if any clinical variables can predict therapeutic outcome.
  
  
  METHODS
  Using a 3:2 randomization ratio, 67 patients with nasal polyposis received 50 mg of prednisolone and 47 patients received placebo daily for 2 weeks, followed by mometasone furoate nasal  spray (MFNS) at 200 micrograms twice daily for 10 weeks. Clinical response was evaluated by nasal symptom score (NSS), peak expiratory flow index (PEFI), and total nasal polyps score (TNPS). Potential predictor variables were assessed by clinical history, nasal endoscopy, allergy skin test,  and sinus radiography.
  
  
  RESULTS
  At the end of the 2-week oral steroid phase, the prednisolone group showed significantly greater improvements in all nasal symptoms, nasal airflow, and polyp size than the placebo group. In the nasal steroid phase, while the MFNS maintained  the outcome improvements in the prednisolone group, all outcome variables in the placebo group showed continuing improvements. At the end of the nasal steroid phase, there were no significant differences of most outcome improvements between the two groups, except in hyposmia, PEFI, and TNPS  (p = 0.049, p = 0.029, and p = 0.005, respectively). In the prednisolone group, patients with polyps grade 3 and endoscopic signs of meatal discharge showed significantly less improvement in total NSS, PEFI, and TNPS than patients with grade 1-2 size and negative metal discharge.
  
  
  CONCLUSIONS
  In the 12-week treatment evaluation of nasal polyposis, pretreatment with oral steroids had no significant advantage for most nasal symptoms other than earlier relief; however, combined oral and nasal steroid therapy more effectively improved hyposmia, polyps size,  and nasal airflow. Polyps size grade 3 and/or endoscopic signs of meatal discharge predisposed to a poorer treatment outcome.
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. kvirat2002@yahoo.com
authors.forename: Virat
authors.initials: V
authors.lastname: Kirtsreesakul
authors.forename: Krongthong
authors.initials: K
authors.lastname: Wongsritrang
authors.forename: Suwalee
authors.initials: S
authors.lastname: Ruttanaphol
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068656:Mometasone Furoate; D009298:Nasal Polyps / Q000188:drug therapy* / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage*; D011244:Pregnadienediols / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D011244:Pregnadienediols; D000068656:Mometasone Furoate; D011239:Prednisolone