Symptomatic Interventions for Allergic Rhinitis Without Comorbid Asthma: A Dose-Stratified Network Meta-analysis.
Sajjad Salimi, Arezoo Hamidi, Mohammad Mahdi Babajani et al.
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In 30 seconds
This systematic review and dose-stratified network meta-analysis compared symptomatic treatments for seasonal and perennial allergic rhinitis in patients without comorbid asthma. It included 175 randomized controlled trials with over 90,000 participants. Treatment rankings differed by outcome, and no regimen consistently outperformed the others. Some higher-dose intranasal corticosteroid monotherapies ranked highly, but substantial heterogeneity and statistical inconsistency limited comparative conclusions. Certainty for total nasal symptom score was moderate to very low for most comparisons, making the findings exploratory rather than definitive.
Key findings
- The analysis included 175 randomized controlled trials encompassing over 90,000 participants.
- No single treatment regimen consistently ranked as superior across outcomes.
- Some higher-dose intranasal corticosteroid monotherapies ranked among the highest in SUCRA analyses, but rankings warrant caution.
- Certainty of evidence for total nasal symptom score was moderate to very low in most comparisons.
Why it matters
The analysis highlights that comparative treatment rankings for allergic rhinitis may depend on the outcome and dose, while current evidence does not establish a universally superior regimen. Persistent heterogeneity and inconsistency mean rankings should not be treated as definitive. The findings underscore the need for better-aligned comparative studies to clarify treatment effects across patient groups and outcomes.
What to keep in mind
Substantial heterogeneity and significant inconsistency persisted in several networks, particularly for total nasal symptom score in seasonal allergic rhinitis. The analysis excluded patients with comorbid asthma.