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Oral steroids and doxycycline: Two different approaches to treat nasal polyps

Thibaut Van Zele UGent, Philippe Gevaert UGent, Gabriële Holtappels UGent, Achim Beule, Peter John Wormald, Susanne Mayr, Greet Hens, Peter Hellings, Fenna Ebbens and Wytske Fokkens, et al. (2010) JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. 125(5). p.1069-1076
abstract
Background: There is little scientific evidence to support the current practice of using oral glucocorticosteroids and antibiotics to treat patients with chronic rhinosinusitis and nasal polyps. Objective: We evaluated the effects of oral glucocorticoids and doxycycline on symptoms and objective clinical and biological parameters in patients with chronic rhinosinusitis and nasal polyps. Methods: In a double-blind, placebo-controlled, multicenter trial, we randomly assigned 47 participants with bilateral nasal polyps to receive either methylprednisolone in decreasing doses (32-8 mg once daily), doxycycline (200 mg on the first day, followed by 100 mg once daily), or placebo for 20 days. Participants were followed for 12 weeks. Patients were assessed for nasal peak inspiratory flow and symptoms and by nasal endoscopy. Markers of inflammation such as eosinophilic cationic protein (ECP), IL-5, myeloperoxidase, matrix metalloproteinase 9, and IgE were measured in nasal secretions. Concentrations of eosinophils, ECP, and soluble IL-5 receptor a were measured in peripheral blood samples. Results: Methylprednisolone and doxycycline each significantly decreased nasal polyp size compared with placebo. The effect of methylprednisolone was maximal at week 3 and lasted until week 8, whereas the effect of doxycycline was moderate but present for 12 weeks. Methylprednisolone significantly reduced levels of ECP, IL-5, and IgE in nasal secretions, whereas doxycycline significantly reduced levels of myeloperoxidase, ECP, and matrix metalloproteinase 9 in nasal secretions. Conclusion: This is the first double-blind, placebo-controlled study to show a significant effect of oral methylprednisolone and doxycycline on size of nasal polyps, nasal symptoms, and mucosal and systemic markers of inflammation. (J Allergy Clin Immunol 2010;125:1069-76.)
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
corticosteroids, double-blind placebo-controlled, antibiotics, chronic rhinosinusitis, nasal polyposis, Staphylococcus aureus, doxycycline, methylprednisolone, double blind, Randomized controlled trial, placebo-controlled
journal title
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
JACI
volume
125
issue
5
pages
1069 - 1076
publisher
MOSBY-ELSEVIER, 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA
place of publication
USA
Web of Science type
article
Web of Science id
000277686700016
JCR category
ALLERGY
JCR impact factor
9.273 (2010)
JCR rank
1/20 (2010)
JCR quartile
1 (2010)
ISSN
0091-6749
DOI
10.1016/j.jaci.2010.02.020
language
English
UGent publication?
yes
classification
A1
id
976788
handle
http://hdl.handle.net/1854/LU-976788
date created
2010-06-11 09:44:35
date last changed
2010-06-23 11:55:10
@article{976788,
  abstract     = {Background: There is little scientific evidence to support the current practice of using oral glucocorticosteroids and antibiotics to treat patients with chronic rhinosinusitis and nasal polyps.
Objective: We evaluated the effects of oral glucocorticoids and doxycycline on symptoms and objective clinical and biological parameters in patients with chronic rhinosinusitis and nasal polyps.

Methods: In a double-blind, placebo-controlled, multicenter trial, we randomly assigned 47 participants with bilateral nasal polyps to receive either methylprednisolone in decreasing doses (32-8 mg once daily), doxycycline (200 mg on the first day, followed by 100 mg once daily), or placebo for 20 days. Participants were followed for 12 weeks. Patients were assessed for nasal peak inspiratory flow and symptoms and by nasal endoscopy. Markers of inflammation such as eosinophilic cationic protein (ECP), IL-5, myeloperoxidase, matrix metalloproteinase 9, and IgE were measured in nasal secretions. Concentrations of eosinophils, ECP, and soluble IL-5 receptor a were measured in peripheral blood samples.

Results: Methylprednisolone and doxycycline each significantly decreased nasal polyp size compared with placebo. The effect of methylprednisolone was maximal at week 3 and lasted until week 8, whereas the effect of doxycycline was moderate but present for 12 weeks. Methylprednisolone significantly reduced levels of ECP, IL-5, and IgE in nasal secretions, whereas doxycycline significantly reduced levels of myeloperoxidase, ECP, and matrix metalloproteinase 9 in nasal secretions.

Conclusion: This is the first double-blind, placebo-controlled study to show a significant effect of oral methylprednisolone and doxycycline on size of nasal polyps, nasal symptoms, and mucosal and systemic markers of inflammation. (J Allergy Clin Immunol 2010;125:1069-76.)},
  author       = {Van Zele, Thibaut and Gevaert, Philippe and Holtappels, Gabri{\"e}le and Beule, Achim and Wormald, Peter John and Mayr, Susanne and Hens, Greet and Hellings, Peter and Ebbens, Fenna and Fokkens, Wytske and Van Cauwenberge, Paul and Bachert, Claus},
  issn         = {0091-6749},
  journal      = {JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY},
  keyword      = {corticosteroids,double-blind placebo-controlled,antibiotics,chronic rhinosinusitis,nasal polyposis,Staphylococcus aureus,doxycycline,methylprednisolone,double blind,Randomized controlled trial,placebo-controlled},
  language     = {eng},
  number       = {5},
  pages        = {1069--1076},
  publisher    = {MOSBY-ELSEVIER, 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA},
  title        = {Oral steroids and doxycycline: Two different approaches to treat nasal polyps},
  url          = {http://dx.doi.org/10.1016/j.jaci.2010.02.020},
  volume       = {125},
  year         = {2010},
}

Chicago
Van Zele, Thibaut, Philippe Gevaert, Gabriële Holtappels, Achim Beule, Peter John Wormald, Susanne Mayr, Greet Hens, et al. 2010. “Oral Steroids and Doxycycline: Two Different Approaches to Treat Nasal Polyps.” Journal of Allergy and Clinical Immunology 125 (5): 1069–1076.
APA
Van Zele, T., Gevaert, P., Holtappels, G., Beule, A., Wormald, P. J., Mayr, S., Hens, G., et al. (2010). Oral steroids and doxycycline: Two different approaches to treat nasal polyps. JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 125(5), 1069–1076.
Vancouver
1.
Van Zele T, Gevaert P, Holtappels G, Beule A, Wormald PJ, Mayr S, et al. Oral steroids and doxycycline: Two different approaches to treat nasal polyps. JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. USA: MOSBY-ELSEVIER, 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA; 2010;125(5):1069–76.
MLA
Van Zele, Thibaut, Philippe Gevaert, Gabriële Holtappels, et al. “Oral Steroids and Doxycycline: Two Different Approaches to Treat Nasal Polyps.” JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY 125.5 (2010): 1069–1076. Print.