Mometasone furoate nasal spray: a systematic review.

UNLABELLED: The inflammatory diseases of the nose, rhino-pharynx and paranasal sinuses (allergic and non allergic rhinitis, NARES; rhinosinusitis with/without nasal polyposis, adenoidal hypertrophy with/without middle ear involvement) clinically manifest themselves with symptoms and complications severely affecting quality of life and health care expenditure. Intranasal administration of corticosteroids, being fast, simple, and not requiring cooperation, is the preferred way to treat the patients, to optimize their quality of life, at the same time minimizing the risk of exacerbations and complications. Among the different topical steroids available on the market, we performed a comparative analysis in terms of effectiveness and safety between mometasone furoate (MF) and its main competitors. Searching through Pub Med and Google Scholar and using as entries "mometasone furoate", "rhinitis", "sinusitis", "asthma", "polyposis", "otitis media with effusion", and "adenoid hypertrophy" we found 344 articles, 300 of which met the eligibility criteria. Taking into account relevance and date of publication, a sample of 40 articles was considered for the review. MF effectiveness for treatment and/or prophylaxis of nasal symptoms in seasonal and perennial allergic rhinitis has been fully established with a level of evidence Ia. Even though it has not been assessed for MF in particular, topical steroids are the most appropriate treatment in mixed rhinitis and NARES. In acute rhinosinusitis (ARS) evidences support their use as mono-therapy or as adjuvant to antibiotics for reducing the recurrence rate, and decrease the usage of related prescriptions and medical consultations. In chronic rhinosinusitis (CRS) with Nasal polyposis, MF reduces polyps size, nasal congestion, improves quality of life and sense of smell and it is also effective in the treatment of daytime cough. The topical use of MF has great efficacy in the management of adenoidal hypertrophy and otitis media of atopic children. As regards the safety, MF has demonstrated an excellent safety profile: pregnant women can safely use it; no systemic effects on growth velocity and adrenal suppression have been shown; no changes in epithelial thickness or atrophy have been observed after long term administration of the drug. CONCLUSIONS: MF has been demonstrated to be effective in the treatment of the inflammatory diseases of the nose and paranasal sinuses; when compared to its competitors it shows a greater symptom control; it is a reliable treatment in the long term thanks not only to its proven efficacy, but also to its safety being on the market since more than 17 years.

Role of prulifloxacin in the treatment of acute rhinosinusitis.

Acute rhinosinusitis (ARS) is a very common/disease faced more often by general practitioners than ear, nose and throat specialists, pneumologists or allergologists. In an outpatients setting, upper respiratory tract infection is the third most common cause of a primary care consultation, one third of which is attributable to ARS, diagnosed upon clinical presentation. In some cases however, signs and symptoms do not allow clear differentiation from viral, post-viral or bacterial infection. This compels GPs and family doctors to make a careful choice and first use the best antimicrobial treatment to avoid recurrences or complications and the rise of antibiotic resistance. Amoxicillin, thanks to its narrow spectrum against likely respiratory pathogens, is recommended as first-line therapy to treat acute bacterial rhinosinusitis by several international guidelines, being safe at the same time. Other antibiotics (beta-lactams, macrolides and newer drugs, such as fluoroquinolones) have been evaluated in double-blind studies versus placebo or comparative studies in terms of efficacy, safety and costs. Prulifloxacin, the active metabolite of ulifloxacin, is an oral fluoroquinolone with a broad in vitro activity spectrum against Gram positive and negative bacteria and among fluoroquinolones has the lowest power of inducing resistance. In vitro and in vivo studies have shown its clinical efficacy and pathogen eradication. Ulifloxacin T(1/2) and plasma and tissue concentrations including the nose-paranasal sinuses mucosa allow once daily administration at the dosage of 600 mg. Prulifloxacin shows a high safety profile: it is the fluoroquinolone with the lowest risk of cardiac arrhythmias for prolongation of the QT interval; the CNS penetration is negligible; in women prulifloxacin does not affect the lactobacillary component of the vaginal microbiota, lowering the risk of genito-urinary tract infections. The pharmacokinetic characteristics and safety profile of prulifloxacin make it the antibiotic option with the best potential to achieve clinical cures and bacteriological eradication, well tolerated and safe without specific restriction or posologic changes in the elderly and in patients with co-morbidities in multiple treatment, hence resolving ARS reliably and being simple and easy to administer.

Auto-reactions, autoimmunity and psoriatic arthritis.

Evidence from the literature suggests that autoimmune processes may drive features of psoriatic arthritis (PsA). Such hypothesis is supported by the evidence that class I major histocompatibility complex (MHC) genes are associated with susceptibility to develop PsA and auto-reactive cells, such as CD8 T cells, T helper (h) 17 and plasma cells, have been demonstrated in PsA. However, no autoantigens have ever been demonstrated in PsA. The presence of a new autoantibody system, anti-carbamylated protein (anti-CarP) antibodies, has been identified in rheumatoid arthritis (RA) patients. These autoantibodies have been associated with a worse disease progression independent of anti-citrulline antibodies (ACPA). In PsA, anti-CarP antibodies have not been evaluated yet. We aimed at analyzing, for the first time, the anti-CarP antibodies in sera of patients with active PsA who were negative for ACPA in order to explore both their presence and their relationship with disease activity. A total of 70 individuals, 30 patients with diagnosis of PsA (according to CASPAR criteria) and 40 healthy controls (HC) were enrolled. We found significantly increased levels of anti-CarP antibodies in PsA patients compared with HC (P<0.0001). Our findings indicate that anti-CarP antibodies are detectable with high specificity and sensibility in PsA patients suggesting an autoimmune background of PsA. Anti-CarP antibodies can be useful in improving the diagnosis of PsA and are correlated with disease activity.