News reports from the conference

Trial shows safety of topical steroid nasal spray for patients with controlled glaucoma

A prospective, randomized controlled trial suggests that topical nasal sprays containing steroids can be used safely for managing rhinitis in patients with controlled glaucoma or ocular hypertension.

This conclusion is based on a trial involving 19 patients with well-controlled mild to moderate primary open-angle glaucoma (POAG) who were randomly assigned to receive either 400 µg/d of beclomethasone nasal spray (n = 9) or placebo saline spray (n = 10) for six weeks. The primary outcome measure was change in intraocular pressure (IOP).

Results of the study were presented by Dr. Darana Yuen, an ophthalmologist at the University of Toronto, who explained that the study was undertaken because steroid use has long been associated with increased IOP and because up to 90% of patients with POAG are steroid responders. With much of the population, including those with glaucoma, experiencing allergic or non-allergic rhinitis for which topical nasal steroids are the most effective treatment option, Yuen said that information is lacking on the impact of these drugs on patients with POAG.

She explained that beclomethasone spray was selected because it has the highest absorption rate of any of the steroid nasal sprays and so its use would be most likely to raise IOP if there is an effect.

Yuen said the analysis showed no statistically significant differences between the study and placebo groups in baseline characteristics, IOP at each of the four study visits, or change in IOP from baseline at any point.

At the end of the study, the change in mean IOP from baseline was +0.50 (SD 1.52) mm Hg for the steroid group and +0.70 (SD 1.44) mm Hg for the placebo group (p = 0.77). In addition, she said no spikes in IOP levels were seen during the study period.

Yuen said compliance with medication was more than 80% in both groups. However, she noted that study limitations included the study size, limited length of follow-up, and the fact that only one subject actually had rhinitis during the trial.

Yuen presented the results on behalf of the research team of Drs. Yvonne Buys, Tariq Alasbali, Yaping Jin and Graham Trope.