Meta-Analyses Of Efficacy And Safety Of Olopatadine-Mometasone Combination Nasal Spray And Different Immunotherapies In The Treatment Of Allergic Rhinitis

Background: Olopatadine-Mometasone Combination Nasal Spray（GSP301）is a fixed-dose combination of olopatadine and mometasone for the treatment of allergic rhinitis（AR）.The clinical guideline for the treatment of AR with glucocorticoids and antihistamines are controversial.The aim of this study was to evaluate the efficacy and safety of GSP301 in the treatment of AR,and to analyze the advantages and disadvantages of combination therapy.Methods: Randomized controlled trials on GSP301 for AR were searched in Pub Med,Cochrane Library,and Embase,the search time is limited to June 2021.According to inclusion and exclusion criteria,literature and data were independently extracted by two researchers.Then the quality of relevant studies was evaluated.R and Stata16.0software were used for data analysis.Results: A total of 5 studies were included in this study.The outcome measures included reflective total nasal symptom score（r TNSS）,instantaneous total nasal symptom score（i TNSS）,reflective total ocular symptom score（r TOSS）,instantaneous total ocular symptom score（i TOSS）,Physician-assessed nasal symptom score（PNSS）,rhinoconjunctivitis quality of life（RQLQ）,rhinitis control assessment test（RCAT）and adverse events（AEs）.GSP301 showed significant short-term（2/6 weeks）improvement in the above indicators compared with placebo.It had no statistically significant long-term（52 weeks）response in PNSS,RQLQ,and RCAT.Major complications of GSP301 include headache,dysgeusia,nasal discomfort,and upper respiratory tract infection.Compared with placebo,GSP301 had no statistically significant risk ratio（RR）for headache,nasal discomfort,and upper respiratory tract infection but it caused dysgeusia in a minority of patients.Conclusion: GSP301 is a safe and well-tolerated medication.It showed short-term benefits for seasonal and perennial AR,but may not help to improve patients’ quality of life and rhinitis occur in the long-run.Compared with monotherapy,the combination therapy has a rapid onset and long-lasting effect.The combination therapy can better relieve the nasal and ocular symptoms of AR patients and improve their quality of life.Background: Immunotherapy has been used for many years in the treatment of allergic rhinitis（AR）.Patients’ symptoms can be relieved by repeated subcutaneous injections or sublingual administration of atopic allergens.The disadvantages of subcutaneous immunotherapy（SCIT）and sublingual immunotherapy（SLIT）are long treatment cycles and low patient compliance.Intralymphatic immunotherapy（ILIT）is a relatively novel immunotherapy method.Patients can achieve a certain immune effect by receiving 3injections of allergens in the groin or neck lymph nodes,which shortens the time of traditional immunotherapy.However,does rapid immunotherapy really work?Furthermore,there is a lack of evidence on which of SCIT,SLIT and ILIT is more effective.The aim of this study was to compare the efficacy of the above three immunotherapies for AR by a network meta-analysis（NMA）.Methods: By searching Pubmed,Cochrane Library and Embase databases,randomized controlled trials with ILIT,SCIT and SLIT as intervention treatment for AR were included for NMA and traditional meta-analysis.Results: A total of 11 articles were included.SLIT was divided into multi-quarter and single-quarter treatment subgroups.The included outcome measures included symptom score（SS）and medication score（MS）.Traditional meta-analysis shows that compared with placebo,SCIT and multi-quarter SLIT can significantly reduce SS,while single-quarter SLIT and ILIT have poor effects.Only SCIT can significantly improve MS.According to NMA,the most effective method to improve SS is multi-quarter SLIT,followed by SCIT,ILIT and SLIT.The most effective method to improve MS was SCIT,followed by ILIT and SLIT.Conclusion: Current evidence suggests that SCIT and multi-quarter SLIT can significantly improve symptoms in AR patients.SCIT has advantages in improving patients’ symptoms and drug dependence.The effect of single-quarter SLIT is not obvious.ILIT has positive effect in the short-term and improves treatment compliance,but the long-term effect is not significant.Clinicians need to choose immunotherapy rationally based on efficacy,compliance and safety.