A randomized comparison of the effects of budesonide and mometasone furoate aqueous nasal sprays on nasal peak flow rate and symptoms in perennial allergic rhinitis

Background Using conventional methods, it has been difficult to show differences in efficacy between intranasal corticosteroids in perennial rhinitis. Objective To compare the effects of budesonide and mometasone on nasal symptoms and nasal airflow in perennial allergic rhinitis. Methods Four hundred thirty-eight patients (age >18 years old) were randomized to budesonide, 256 μg or 128 μg, mometasone furoate 200 μg, or placebo, once daily for 4 weeks. Efficacy was evaluated by nasal index score (NIS; the sum of scores for blocked nose, runny nose, and itchy nose/sneezing) and peak nasal inspiratory flow (PNIF). Results All three active treatments significantly reduced the NIS compared with placebo. There was no significant difference between the treatments, although the effect of budesonide, 256 μg, tended to be greater than that of the other regimens. PNIF was significantly improved with all three active treatments: the effect of budesonide 256 μg on morning and evening PNIF was significantly greater than that of mometasone furoate and 128 μg budesonide. Budesonide had a rapid onset of action, showing a significantly greater effect on evening PNIF than mometasone furoate during the first 10 days. For all active treatments, significant improvements in NIS were seen within 4 hours of the first dose. All three treatments were well tolerated. Conclusion The objective parameter PNIF was capable of demonstrating greater efficacy of budesonide 256 μg compared with budesonide 128 μg and mometasone furoate 200 μg, whereas the combined nasal symptom score could only distinguish active treatment from placebo.