1. Should Oral Corticosteroids be Used in Medical Therapy for Chronic Rhinosinusitis? A Risk Analysis.
- Author
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Leung RM, Smith TL, Kern RC, Chandra RK, Schlosser RJ, Harvey RJ, Conley DB, and Lee JM
- Subjects
- Administration, Oral, Chronic Disease therapy, Clinical Decision-Making, Computer Simulation, Endoscopy adverse effects, Glucocorticoids administration & dosage, Humans, Likelihood Functions, Male, Middle Aged, Monte Carlo Method, Nasal Polyps immunology, Nasal Surgical Procedures adverse effects, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications prevention & control, Rhinitis immunology, Risk Assessment methods, Risk Assessment statistics & numerical data, Sinusitis immunology, Treatment Outcome, Glucocorticoids adverse effects, Nasal Polyps therapy, Rhinitis therapy, Sinusitis therapy
- Abstract
Objectives: Oral corticosteroid (OCS) as a part of appropriate medical therapy (AMT) (formerly maximal medical therapy) in chronic rhinosinusitis remains controversial. While the risks of OCS are well known, the benefit remains unclear due the absence of a standardized prescribing regimen. Consequently, it is difficult to characterize whether the risks of OCS and its ability to avert endoscopic sinus surgery (ESS) are helpful in AMT. When OCS is highly effective at averting surgery, the lesser risks of OCS would be justified because it can avoid the greater risks of ESS. When OCS is poorly effective at averting ESS, the risks of OCS would not be justified because many patients will be exposed to both risks. This study seeks to identify the threshold effectiveness of OCS at averting ESS that would minimize risk exposure to patients., Methods: A probabilistic risks-based decision analysis was constructed from literature reported incidences and impacts of adverse events of OCS and ESS. Monte Carlo analysis was performed to identify the minimum effectiveness required to avoid further intervention (MERAFI) for chronic sinusitis without nasal polyp (CRSsNP) and chronic sinusitis with nasal polyp (CRSwNP)., Results: The analysis showed MERAFI results of 20.8% (95% CI 20.7-20.9%) for CRSsNP and 16.8% (95% CI 16.7-16.9%) for CRSwNP., Conclusions: Given reported OCS effectiveness in the range of 34-71% in CRSsNP and 46-63% in CRSwNP, this analysis suggests that the inclusion of OCS in AMT may be the lower risk strategy., Level of Evidence: N/A Laryngoscope, 131:473-481, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)
- Published
- 2021
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