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

Abstract Background Using intranasal corticosteroid (INCS) regularly is recommended for treating perennial allergic rhinitis (PAR). However, no studies have evaluated “as-needed” use. Objective To compare the efficacy between as-needed and regular use of INCS in moderate-to-severe PAR patients. 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 (NPIF), Rhinoconjunctivitis Quality of Life-36 Questionnaire Score (RCQ-36), and cumulative FF dose. Results One hundred and three patients, 51 in FF-as-needed and 52 in FF-regular, completed the study. The difference in mean change of TNSS between the two groups was not significant at week 6 (1.21 points; 95% CI, -0.08 to 2.49; P = 0.066). The FF-regular group tended towards a greater improvement in TNSS. The FF-regular group had higher mean change of NPIF than the FF-as-needed group at week 6 (-19.21 L/min; 95%CI, -33.54, -4.89; P=0.009). Both groups had similar improvement in RCQ-36. The mean cumulative FF dose in the FF-as-needed group was 51 % that of the FF-regular group. Conclusion Both as-needed and regular use of INCS had similar improvement in TNSS and RCQ-36 in PAR patients. As-needed use had half of INCS exposure of the regular use.