A Meta-Analysis of Topical Amphotericin B for the Treatment of Chronic Rhinosinusitis
Rhinologists at the Texas Sinus Institute of the Department of Otorhinolaryngology-Head and Neck Surgery at The University of Texas Medical School at Houston and Memorial Hermann-Texas Medical Center are engaged in research efforts that drive the innovation that provides tomorrow’s advances. The following report was presented at the 56th Annual Meeting of the American Rhinologic Society, held in Boston on September 25, 2010.
In 2003, the Mayo Clinic received broad patent coverage for a treatment of chronic rhinosinusitis (CRS) based on studies demonstrating that the delivery of antifungal drugs directly into the nose and sinuses significantly reduced symptoms of the disorder. The interpretation that fungus is implicated in all patients with CRS led to the recommendation by several authors that antifungal irrigations may be used as a first line of treatment for CRS, a standard many otolaryngologists still follow.
“Later studies of the efficacy of antifungal agents did not produce the same results as the original Mayo Clinic study,” says Samer Fakhri, MD, FACS, an associate professor of otorhinolaryngology-head and neck surgery at The University of Texas Medical School at Houston.
To shed light on this issue, Dr. Fakhri and his colleagues at UTHealth’s Texas Sinus Institute and Memorial Hermann-Texas Medical Center conducted a meta-analysis using Medline and PubMed databases and found 10 English-language articles written between 1999 and 2009, six of which met their inclusion criteria: studies with polypoid and non-polypoid CRS patients, reported concentrations of topical amphotericin B (AMB) and follow-up with objective outcomes measured. Of those six, three prospective placebo-controlled studies that included CT data—Ponikau, et al (2005), Wescheta, et al (2004) and Gerlinger, et al (2008)—were selected for inclusion in the meta-analysis conducted between January and June 2010.
“Pooling patients from these three studies revealed no significant difference between the amphotericin B-treated and control groups when CT scores were characterized into positive or unchanged/worse categories,” Dr. Fakhri says. “Of the three studies, only the Wescheta trial showed a difference between the two groups, with amphotericin B-treated patients in fact showing a significantly poorer outcome.”
The UT research team also reviewed endoscopy scores and assessed the mean change in endoscopic scores pre- and post-treatment between control and AMB-treated patients. “With no discernible difference between topical amphotericin B and the saline controls, our straightforward conclusion is that the current practice of adding amphotericin B is not supported by published data,” he says. “That does not disprove the concept of a fungal etiology in at least some CRS patients. In fact, the role of fungus in CRS is an area of intense basic science and translational research at this institution.”