Early View e23578
ORIGINAL ARTICLE
Yuan Zhang, Yuan Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China Search for more papers by this author Zengxiao Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China Search for more papers by this author Corresponding Author Chengshuo Wang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China Search for more papers by this author Corresponding Author Luo Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China Search for more papers by this author
Yuan Zhang, Yuan Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China Search for more papers by this author Zengxiao Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China Search for more papers by this author Corresponding Author Chengshuo Wang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China Search for more papers by this author Corresponding Author Luo Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China Search for more papers by this author
First published: 26 March 2025
Yuan Zhang and Zengxiao Zhang should be considered joint first author.
Funding: This study was supported by grants from Beijing Hospitals Authority Clinical Medicine Development of Special Funding (ZLRK202303), National Key R&D Program of China (2022YFC2504100), the Program for the Changjiang Scholars and Innovative Research Team (IRT13082), Natural Science Foundation of China (82471132 and 82371115), and Beijing Municipal Science and Technology Commission (Z211100002921060).
ABSTRACT
Background
Combination pharmacotherapies are often selected for moderate-to-severe allergic rhinitis (AR), particularly when monotherapies do not control symptoms effectively. However, few studies have compared the efficacy and safety of different combination regimens. Therefore, we performed this study to investigate the clinical benefits of different combination strategies for moderate-to-severe AR.
Methods
Electronic databases were searched (inception-May 31, 2024) for randomized controlled trials involving combination therapies for treating moderate-to-severe AR. The medication classes included intranasal corticosteroids (INCS), intranasal antihistamines (INAH), oral antihistamines (OAH), and oral leukotriene receptor antagonists (LTRA). A network meta-analysis with a random-effects model was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Forty-eight eligible studies with 17,188 participants were included. In this meta-analysis, INAH and INCS, OAH and INCS, and INCS were the most effective in improving Total Nasal Symptom Score, and INAH and INCS, INAH, and INCS most effectively enhanced the total ocular symptom score. INCS and LTRA, OAH and INCS, and INAH and INCS showed the greatest benefit in improving the Rhinitis Quality of Life Questionnaire. Although INCS and INAH and INAH increased the risk of overall adverse events, specific adverse events predominantly included a bitter taste.
Conclusion
Combination therapies demonstrated superior efficacy compared to monotherapies overall. The INAH and INCS combination provided the greatest advantage in symptom improvement. The combination of OAH and INCS could be a viable alternative treatment option if the bitter taste is unacceptable. Our findings provide novel insights into optimizing personalized combination therapies.
Conflicts of Interest
The authors declare no conflicts of interest.
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