Medication adherence, sensory attributes, and adverse effects of intranasal corticosteroids in allergic rhinitis patients: A systematic review and meta-analysis

Intranasal corticosteroid (INCS) remains the primary treatment for allergic rhinitis (AR). Understanding adherence, safety concerns and sensory preferences is crucial for optimal care. This review aims to determine medication adherence, sensory attributes and adverse effects of INCS in AR patients. A systematic search of PubMed, Web of Science, Scopus, and Cochrane database was conducted for English articles published from 2004 to 2023. Eligibility includes clinical trials and observational studies with adult patients (18 years old or older) receiving INCS for AR (both intermittent and persistent). Thirty-one studies with 10,582 patients, comprising 10 cross-sectional studies and 21 randomized controlled trials (RCT) were included. Adherence rates ranged from 28% to 87%, with an average of 55.8%. Forgetfulness was the primary reason for non-adherence (63.1-77.8%), followed by adverse events (26.4-61.5%) and fear of adverse events (3.8-31.5%). Scent (38%), taste (28.5%), or aftertaste (24.3%) were the main differentiators for sensory attribute, with varying levels of intensity and preferences for each INCS. Common adverse events encompass epistaxis, nasal dryness/irritation, headache and nasopharyngitis. A meta-analysis of eight RCT detected no significant difference in adverse events between the INCS and control groups (risk ratio 1.05; 95% confidence interval, 0.88-1.24; p = 0.61). The findings of this review indicate that medication adherence to INCS is not optimal, with non-adherence mostly attributed to forgetfulness, preferences for sensory attributes, and unpleasant effects associated with INCS. The underlying factors should be addressed as part of a multimodal strategy to improve adherence.