96 Chapter 2 Corticosteroids versus placebo Question: Corticosteroids compared to placebo for patients with allergic rhinitis Bibliography: Al Sayyad, 2007; Penagos, 2008; Rodrigo, 2010 [6-8] Certainty assessment Summary of findings № of participants (studies) Risk of bias Inconsistency Indirectness Imprecision Publication bias Overall certainty of evidence Study event rates (%) Relative effect (95% CI) Anticipated absolute effects With placebo With corticosteroids Risk with placebo Risk difference with corticosteroids Nasal symptoms (mometasone) (assessed with: total nasal symptom score) 1878 (10 RCTs) not serious serious a not serious not serious none ⨁⨁⨁◯ MODERATE 911 967 - - SMD 0.56 SD lower (0.71 lower to 0.41 lower) Non-nasal symptoms (mometasone) 1009 (4 RCTs) not serious not serious serious b not serious none ⨁⨁⨁◯ MODERATE 502 507 - - SMD 0.3 SD lower (0.43 lower to 0.18 lower) Ocular symptoms (fluticasone, seasonal allergic rhinitis) (assessed with: Mean change in daily reflective total ocular symptom score) 2219 (6 RCTs) very serious c not serious not serious not serious none ⨁⨁◯◯ LOW 1112 1107 - MD 0.54 lower (0.7 lower to 0.37 lower) Ocular symptoms (fluticasone, perennial allergic rhinitis) (assessed with: Mean change in daily reflective total ocular symptom score) 919 (3 RCTs) very serious c not serious not serious not serious none ⨁⨁◯◯ LOW 455 464 - MD 0.33 lower (0.61 lower to 0.05 lower) CI: Confidence interval; SMD: Standardised mean difference; MD: Mean difference; SD: standard deviation a. Moderate inconsistency between trial results; I2=58% b. The outcome reported is 'non-nasal symptom scores', including ocular symptoms, otic, palate and throat complaints, cough, etc. For this outcome, we are interested in ocular symptoms only, therefore we downgraded for indirectness. c. Unclear randomisation and allocation in almost all included studies; all studies were sponsored by pharmaceutical industries
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