Combination therapy of allergic rhinitis: efficacy, safety and impact on quality of life

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Abstract

Currently, allergic rhinitis is one of the most common allergic diseases, and its significance is often underestimated by both doctors and patients, resulting in increased severity, decreased physical, professional, and social activity, sleep disturbance, and the impairment of the quality of life.

Despite modern drug availability, the control level over allergic rhinitis symptoms in routine clinical practice remains low. Patients who do not receive a quick result from using intranasal glucocorticosteroids, which have anti-inflammatory and pathogenetic properties, prefer fast-acting decongestants instead, which can lead to chronization and adverse events. The use of intranasal glucocorticosteroids and antihistamines combination, which have additive effects on the key pathogenesis stages of allergic inflammation, allows for rapid treatment of the most severe rhinitis symptoms and can improve adherence to therapy.

This review presents the results of clinical studies and key characteristics of the new nasal spray of the olopatadine and mometasone fixed combination, confirming the high efficacy and good safety profile of olopatadine + mometasone. The administration of olopatadine and mometasone fixed combination provides rapid relief from nasal and ocular symptoms in patients with allergic rhinitis, ultimately leading to an improvement in the quality of life.

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ADDITIONAL INFORMATION

Funding source.This study was supported by Glenmark.

Competing interests.The authors declare that they have no competing interests.

Author contribution. The contribution of all authors to the work is equal. All authors made a substantial contribution to the conception of the work, acquisition, analysis, interpretation of data for the work, drafting and revising the work, final approval of the version to be published and agree to be accountable for all aspects of the work.

 

Table 1. Stepwise approach for Allergic Rhinitis Management

 

Иммунотерапия (АСИТ)

Контроль факторов внешней среды (элиминационные мероприятия)

Фармакотерапия для контроля симптомов

1-я ступень

2-я ступень

3-я ступень

4-я ступень (лечение только специалистом)

Один из:

·                     нсН1-АГ

·                     интраназальные АГ

·                     кромоглициевая кислота (назальный препарат)

·                     АЛР

Один из:

·                     ИНГКС (предпочтительно)

·                     нсН1-АГ

·                     интраназальные АГ

·                     АЛР

Комбинация ИНГКС с одним или более из:

·                     нсН1-АГ

·                     интраназальные АГ

·                     АЛР

·                     Рассмотреть терапию тяжелого АР омализумабом

·                     Рассмотреть хирургическое лечение сопутствующей патологии

Препараты скорой помощи

Адреномиметики коротким курсом

Глюкокортикоиды (системного действия, пероральные)

Перепроверить диагноз и/или приверженность лечению либо влияние сопутствующих заболеваний и/или анатомических аномалий, прежде чем увеличивать терапию (step-up)

     

Note: nsH1-AH – non-sedative systemic H1 antihistamine (second generation); LTRA – leukotriene receptor antagonists; INCS – intranasal corticosteroids – corticosteroids for topical, nasal application (ATC code R01AD).

Table 2. Frequency of adverse events in Ryaltris ® studies

     Investigational drug 

 

Adverse event

Olopatadine+

mometasone

(N=789)

Olopatadine

(N=751)

Mometasone

(N=746)

Placebo

(N=776)

Dysgeusia

3.0%

2.1%

0.0%

0.3%

Epistaxis

1.0%

1.5%

0.8%

0.6%

Nasal discomfort

1.0%

0.3%

0.5%

0.8%

Figure 1. Visual analog scale AR

Figure 2. Mean change in scores from baseline to day 15 on the RQLQ(S) scale with Ryaltris® compared with placebo

×

About the authors

Ksenia S. Pavlova

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

Author for correspondence.
Email: ksenimedical@gmail.com
ORCID iD: 0000-0002-4164-4094
SPIN-code: 7593-0838
Scopus Author ID: 7004658159
ResearcherId: P-9255-2017

MD, Cand. Sci. (Med.)

Россия, 24, Kashirskoe shosse, Moscow, 115522

Darya S. Kulichenko

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

Email: darya.mdinaradze@yandex.ru
ORCID iD: 0000-0002-7375-1759
SPIN-code: 2036-0430

младший научный сотрудник

Россия, 24, Kashirskoe shosse, Moscow, 115522

Oksana M. Kurbacheva

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

Email: kurbacheva@gmail.com
ORCID iD: 0000-0003-3250-0694
SPIN-code: 5698-6436

MD, Dr. Sci. (Med.), Professor

Россия, 24, Kashirskoe shosse, Moscow, 115522

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Supplementary files

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2. Fig. 1. Visual analog scale allergic rhinitis.

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3. Fig. 2. Mean change in scores from baseline to day 15 on the RQLQ(s) scale with combined (olopatadine + mometasone) nasal spray compared with placebo.

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