As-Needed Versus Regular Use of Fluticasone Furoate Nasal Spray in Patients with Moderate to Severe, Persistent, Perennial Allergic Rhinitis: A Randomized Controlled Trial

Background: Using intranasal corticosteroid (INCS) regularly is recommended for treating perennial allergic rhinitis. However, no studies have evaluated "as-needed" use.

Objective: To compare the efficacy between as-needed and regular use of INCS in patients with moderate to severe perennial allergic rhinitis.

Methods: In a 6-week randomized controlled trial, participants were assigned to either fluticasone furoate (FF) nasal spray, (27.5 μg) 2 sprays once daily for 1 week, followed by as-needed use (FF-as-needed) for 5 more weeks or 2 sprays once daily for 6 weeks (FF-regular). The primary outcome was a change in the total nasal symptom score (TNSS). The secondary outcomes were the change in nasal peak inspiratory flow, Rhinoconjunctivitis Quality of Life-36 Questionnaire score, and cumulative FF dose.

Results: In total of 108 patients, 53 and 55 patients were randomized to the FF-as-needed and FF-regular group, respectively. The difference in mean change in TNSS between the 2 groups was not significant at week 6 (1.21 points; 95% CI, -0.08 to 2.49; P = .066). The FF-regular group tended toward a greater improvement in TNSS. The FF-regular group had a higher mean change in nasal peak inspiratory flow than the FF-as-needed group at week 6 (-19.21 L/min; 95% CI, -33.54 to -4.89; P = .009). Both groups had similar improvement in Rhinoconjunctivitis Quality of Life-36 Questionnaire. The mean cumulative FF dose in the FF-as-needed group was 51% that of the FF-regular group.

Conclusions: Both as-needed and regular use of INCS had similar improvement in TNSS and RCQ-36 score in patients with perennial allergic rhinitis. As-needed use had half of INCS exposure of the regular use.