Efficacy and Safety of Combined Pharmacotherapies in Moderate‐to‐Severe Allergic Rhinitis: A Network Meta‐Analysis (2025)

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,

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

Chengshuo Wang,

Corresponding Author

Chengshuo Wang

  • [emailprotected]

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

Luo Zhang,

Corresponding Author

Luo Zhang

  • [emailprotected]

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,

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

Chengshuo Wang,

Corresponding Author

Chengshuo Wang

  • [emailprotected]

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

Luo Zhang,

Corresponding Author

Luo Zhang

  • [emailprotected]

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.

References

Early View

Online Version of Record before inclusion in an issue

e23578

  • References
  • Related
  • Information

Efficacy and Safety of Combined Pharmacotherapies in Moderate‐to‐Severe Allergic Rhinitis: A Network Meta‐Analysis (4)

Close Figure Viewer

Previous FigureNext Figure

Caption

Download PDF

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.

Efficacy and Safety of Combined Pharmacotherapies in Moderate‐to‐Severe Allergic Rhinitis: A Network Meta‐Analysis (2025)

References

Top Articles
Latest Posts
Recommended Articles
Article information

Author: Fr. Dewey Fisher

Last Updated:

Views: 5853

Rating: 4.1 / 5 (62 voted)

Reviews: 85% of readers found this page helpful

Author information

Name: Fr. Dewey Fisher

Birthday: 1993-03-26

Address: 917 Hyun Views, Rogahnmouth, KY 91013-8827

Phone: +5938540192553

Job: Administration Developer

Hobby: Embroidery, Horseback riding, Juggling, Urban exploration, Skiing, Cycling, Handball

Introduction: My name is Fr. Dewey Fisher, I am a powerful, open, faithful, combative, spotless, faithful, fair person who loves writing and wants to share my knowledge and understanding with you.