Clinical trial NCT00841802: Chronic Rhinosinusitis With or Without Nasal Polyps Steroid Study
Official title: Glucocorticosteroid Action in Inflammatory Disease
Study type: INTERVENTIONAL
Overall status: WITHDRAWN
Phase: PHASE4
Conditions: Chronic Sinusitis
Rhinosinusitis
Nasal Polyps
Keywords: Chronic sinusitis
Chronic rhinosinusitis
Nasal polyps
Lead sponsor: Northwestern University
Sponsor class: OTHER
Collaborators: name: National Heart, Lung, and Blood Institute (NHLBI)
First posted: 2009-02-11
Enrollment: 0
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a study to evaluate the cause of chronic sinus disease. Oral steroids have long been used in the treatment of inflammatory conditions including chronic sinusitis, asthma, and arthritis. However, it is not well known exactly which patients will benefit from steroids when used in the treatment of chronic sinusitis. For some doctors, it is common practice to use these medications prior to planned sinus surgery, to lessen the inflammation and possibly help the healing process. Other doctors feel oral steroids may not be helpful in this way, and there is no conclusive data as to whether this practice has a long term benefit.

Detailed description: The purpose of this research study is to better understand how this potential treatment option, oral steroids, affects biochemical substances that have been associated with the development of chronic sinusitis and polyps. In order to do this, we need to study people with different forms of chronic sinusitis and compare them to individuals without allergies or sinus disease. We will also look at patients with chronic sinusitis who are treated with oral steroids and compare them to chronic sinus patients who have not received oral steroid therapy prior to surgery. This study may help pave the way to new treatments that address specific parts of the chronic sinus inflammatory pathway.

Hypotheses

1. Oral steroid treatment of patients with CRS will lead to a correction in the inflammation that is observed in sinonasal tissues, nasal brushings, and nasal lavage.
2. Steroid induced changes in inflammation will differ in chronic sinus patients with polyps than in those without polyps.
3. Changes in inflammation will correlate with clinical variables.

Eligibility criteria: Inclusion Criteria:

* Ages 18 years to 70 years
* Diagnosis of chronic rhinosinusitis (CRS) with nasal polyps (NP) and will be undergoing sinonasal surgery for this condition
* Diagnosis of CRS without NP and will be undergoing sinonasal surgery for this condition
* No diagnosis of CRS and NP and will be undergoing nasal surgery (septoplasty/rhinoplasty, nasal fracture repair,etc.)

Exclusion Criteria:

* Ages younger than 18 years and ages older than 70 years
* Diagnosis of an established immunodeficiency, pregnancy, coagulation disorder, a diagnosis of allergic fungal sinusitis (AFS), or cystic fibrosis
* Those with CRS with or without NP in whom systemic steroid therapy would be contraindicated
* Those who are dependent on systemic steroid therapy for sinonasal disease or any other condition

Primary outcomes:
measure: Alterations of inflammatory cells, levels of key antibodies and cytokines, and expression of key epithelial genes
timeFrame: Prior to surgery and steroid treatment and day of surgery w/ or w/o having been treated w/ steroids
Secondary outcomes:
Other outcomes:
Locations:
city: Chicago
country: United States
facility: Northwestern University
state: Illinois
Study officials:
affiliation: Northwestern University and Northwestern Memorial Hospital
name: Robert P Schleimer, PhD
role: PRINCIPAL_INVESTIGATOR
References:
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citation: Richer SL, Truong-Tran AQ, Conley DB, Carter R, Vermylen D, Grammer LC, Peters AT, Chandra RK, Harris KE, Kern RC, Schleimer RP. Epithelial genes in chronic rhinosinusitis with and without nasal polyps. Am J Rhinol. 2008 May-Jun;22(3):228-34. doi: 10.2500/ajr.2008.22.3162.
citation: Kato A, Peters A, Suh L, Carter R, Harris KE, Chandra R, Conley D, Grammer LC, Kern R, Schleimer RP. Evidence of a role for B cell-activating factor of the TNF family in the pathogenesis of chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2008 Jun;121(6):1385-92, 1392.e1-2. doi: 10.1016/j.jaci.2008.03.002. Epub 2008 Apr 14.
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citation: Schleimer RP, Kato A, Kern R, Kuperman D, Avila PC. Epithelium: at the interface of innate and adaptive immune responses. J Allergy Clin Immunol. 2007 Dec;120(6):1279-84. doi: 10.1016/j.jaci.2007.08.046. Epub 2007 Oct 18.
citation: Kato A, Schleimer RP. Beyond inflammation: airway epithelial cells are at the interface of innate and adaptive immunity. Curr Opin Immunol. 2007 Dec;19(6):711-20. doi: 10.1016/j.coi.2007.08.004. Epub 2007 Oct 24.
citation: Kato A, Favoreto S Jr, Avila PC, Schleimer RP. TLR3- and Th2 cytokine-dependent production of thymic stromal lymphopoietin in human airway epithelial cells. J Immunol. 2007 Jul 15;179(2):1080-7. doi: 10.4049/jimmunol.179.2.1080.
citation: Schleimer RP, Lane AP, Kim J. Innate and acquired immunity and epithelial cell function in chronic rhinosinusitis. Clin Allergy Immunol. 2007;20:51-78.
citation: Kato A, Truong-Tran AQ, Scott AL, Matsumoto K, Schleimer RP. Airway epithelial cells produce B cell-activating factor of TNF family by an IFN-beta-dependent mechanism. J Immunol. 2006 Nov 15;177(10):7164-72. doi: 10.4049/jimmunol.177.10.7164.
citation: Conley DB, Tripathi A, Seiberling KA, Schleimer RP, Suh LA, Harris K, Paniagua MC, Grammer LC, Kern RC. Superantigens and chronic rhinosinusitis: skewing of T-cell receptor V beta-distributions in polyp-derived CD4+ and CD8+ T cells. Am J Rhinol. 2006 Sep-Oct;20(5):534-9. doi: 10.2500/ajr.2006.20.2941.
citation: Lane AP, Truong-Tran QA, Schleimer RP. Altered expression of genes associated with innate immunity and inflammation in recalcitrant rhinosinusitis with polyps. Am J Rhinol. 2006 Mar-Apr;20(2):138-44.
citation: Anand VK, Kacker A, Orjuela AF, Huang C, Manarey C, Xiang J. Inflammatory pathway gene expression in chronic rhinosinusitis. Am J Rhinol. 2006 Jul-Aug;20(4):471-6. doi: 10.2500/ajr.2006.20.2891.
citation: Schleimer RP. Glucocorticoids suppress inflammation but spare innate immune responses in airway epithelium. Proc Am Thorac Soc. 2004;1(3):222-30. doi: 10.1513/pats.200402-018MS.
citation: Zhang N, Truong-Tran QA, Tancowny B, Harris KE, Schleimer RP. Glucocorticoids enhance or spare innate immunity: effects in airway epithelium are mediated by CCAAT/enhancer binding proteins. J Immunol. 2007 Jul 1;179(1):578-89. doi: 10.4049/jimmunol.179.1.578.
citation: Bolger WE, Joshi AS, Spear S, Nelson M, Govindaraj K. Gene expression analysis in sinonasal polyposis before and after oral corticosteroids: a preliminary investigation. Otolaryngol Head Neck Surg. 2007 Jul;137(1):27-33. doi: 10.1016/j.otohns.2007.01.023.