A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps.
Publication/Presentation Date
4-1-2018
Abstract
BACKGROUND: Topical intranasal corticosteroid sprays (INCSs) are standard treatment for nasal polyps (NPs), but their efficacy is reduced by poor patient compliance and impaired access of drug to the sinus mucosa. A corticosteroid-eluting sinus implant was designed to address these limitations in patients with recurrent polyposis after sinus surgery by delivering 1350 μg of mometasone furoate (MF) directly to the ethmoid sinus mucosa over approximately 90 days.
METHODS: A randomized, sham-controlled, double-blind trial was undertaken in 300 adults with refractory chronic rhinosinusitis with NPs (CRSwNP), who were candidates for repeat surgery. Eligible patients were randomized (2:1) and underwent in-office bilateral placement of 2 implants or a sham procedure. All patients used the MF INCS 200 μg once daily. Co-primary efficacy endpoints were the change from baseline in nasal obstruction/congestion score and bilateral polyp grade, as determined by an independent panel based on centralized, blinded videoendoscopy review.
RESULTS: Patients treated with implants experienced significant reductions in both nasal obstruction/congestion score (p = 0.0074) and bilateral polyp grade (p = 0.0073) compared to controls. At day 90, implants were also associated with significant reductions in 4 of 5 prespecified secondary endpoints compared to control: proportion of patients still indicated for repeat sinus surgery (p = 0.0004), percent ethmoid sinus obstruction (p = 0.0007), nasal obstruction/congestion (p = 0.0248), and decreased sense of smell (p = 0.0470), but not facial pain/pressure (p = 0.9130). One patient experienced an implant-related serious adverse event (epistaxis).
CONCLUSION: Significant improvements over a range of subjective and objective endpoints, including a reduction in the need for sinus surgery by 61%, suggest that MF sinus implants may play an important role in management of recurrent NP.
Volume
8
Issue
4
First Page
471
Last Page
481
ISSN
2042-6984
Published In/Presented At
Kern, R. C., Stolovitzky, J. P., Silvers, S. L., Singh, A., Lee, J. T., Yen, D. M., Iloreta, A. M. C., Jr, Langford, F. P. J., Karanfilov, B., Matheny, K. E., Stambaugh, J. W., Gawlicka, A. K., & RESOLVE II study investigators (2018). A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps. International forum of allergy & rhinology, 8(4), 471–481. https://doi.org/10.1002/alr.22084
Disciplines
Medicine and Health Sciences
PubMedID
29350840
Department(s)
Department of Surgery
Document Type
Article