Efficacy of the Exhalation Delivery System With Fluticasone for Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

OBJECTIVES

Novel biomechanics of the exhalation delivery system can deliver fluticasone (EDS-FLU; XHANCE) to sinonasal areas above the inferior turbinate, especially sinus drainage pathways not reached by standard nasal sprays. This study aimed to evaluate the effectiveness of EDS-FLU in treating chronic rhinosinusitis (CRS).

METHODS

Studies were retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to April 2024. We analyzed 5 studies that compared EDS-FLU with a control group (exhalation delivery system with placebo) on various outcomes, including the 22-item Sinonasal Outcome Test (SNOT-22), nasal symptom scores (congestion, facial pain, olfactory dysfunction, and rhinorrhea), nasal polyp scores, surgical indication rate, and the incidence of adverse effects.

RESULTS

Five studies with 2129 patients were included. EDS-FLU significantly improved SNOT-22 score (-20.9657 [-23.5639; -18.3674]) and the polyp score (-1.5099 [-1.7810; -1.2388]) after 6 months. The incidence of epistaxis was significantly higher in the treatment group compared to the control group (OR = 5.7954 [2.1004; 15.9909]). Effects of EDS-FLU on polyp score (-0.6497 [-0.8186; -0.4807]), responder rate (OR = 2.1755 [1.2784; 3.7020]), complete responder rate (OR = 2.0423 [1.0109; 4.1262]), surgical indication rate (OR = 0.7313 [0.5459; 0.9797]), and SNOT-22 score (-6.1513 [-11.3054; -0.9972]) were significantly higher in the treatment group than in the control group.

CONCLUSIONS

This study demonstrated that EDS-FLU (372 µg twice daily) produced statistically significant improvements compared to EDS-placebo in multiple subjective and objective outcomes, although some adverse effects, such as epistaxis, may occur.