mometasone-furoate and Adrenal-Insufficiency

This study evaluates the efficacy and systemic tolerability of licensed doses of mometasone furoate (Nasonex) and betamethasone sodium phosphate (Betnesol) in allergic chronic rhinosinusitis patients. It also assesses the diagnostic accuracy of morning salivary cortisol (MSC) concentrations to screen for adrenal suppression in these patients. Forty-eight patients were prospectively randomized to two treatment limbs. Symptom scores and adrenal function assessments were performed immediately prior to commencement and at the end of treatment. One (4 per cent) mometasone furoate and 14 (58 per cent) betamethasone sodium phosphate patients developed biochemical evidence of adrenal suppression. There were statistically significant (p < 0.005) reductions in symptom scores following treatment, but no significant difference (p > 0.05) between the drug groups regarding post-treatment symptom scores. As a screening tool for iatrogenic adrenal suppression, MSC had a sensitivity of 100 per cent and a specificity of 97 per cent. This study demonstrates the high risk of developing adrenal suppression secondary to betamethasone sodium phosphate therapy. The salivary cortisol assay is an accurate tool for monitoring adrenal function and is ideally suited to the out-patient setting.

Topics: Adolescent; Adrenal Insufficiency; Adult; Aged; Ambulatory Care; Anti-Allergic Agents; Anti-Inflammatory Agents; Betamethasone; Female; Humans; Hydrocortisone; Male; Middle Aged; Mometasone Furoate; Pregnadienediols; Prospective Studies; Rhinitis, Allergic, Perennial; Saliva; Sensitivity and Specificity; Sinusitis; Treatment Outcome

The therapy for skin diseases with topical glucocorticoids is limited by their local and systemic side effects. A glucocorticoid with an improved benefit-to-risk ratio is desirable.. A new topical corticoid, methylprednisolone aceponate (MPA) 0.1% ointment, was compared with the same formulation of mometasone furoate.. The two ointments were compared with respect to suppression of UVB light-induced erythema (n = 20) and with respect to atrophogenicity and appearance of telangiectasia (n = 20) in two double-blind trials with intraindividual comparisons in healthy volunteers. In a third trial, serum cortisol levels were measured in volunteers receiving extensive (60% of body surface) cutaneous application of MPA (n = 10) or mometasone furoate (n = 11).. MPA and mometasone furoate were equally effective in suppressing UVB light-induced erythema. Atrophogenicity, as well as the incidence and severity of telangiectasia, were significantly more pronounced with mometasone furoate than with MPA. Both ointments decreased serum cortisol levels and did not differ significantly in this respect. However, the incidence of serum cortisol level suppression was higher in the mometasone furoate group than in the MPA group.. MPA ointment has equal antiinflammatory activity and similar cortisol suppression but significantly fewer local side effects than mometasone furoate.

Topics: Administration, Topical; Adolescent; Adrenal Insufficiency; Adult; Anti-Inflammatory Agents; Double-Blind Method; Erythema; Female; Glucocorticoids; Humans; Male; Methylprednisolone; Middle Aged; Mometasone Furoate; Ointments; Pregnadienediols; Radiation Injuries; Telangiectasis; Ultraviolet Rays