Background
Allergic rhinitis (AR) is a common condition caused by an immune response to allergens such as pollens, dust mites, or pet dander. Its treatment includes a combination of pharmacological and non-pharmacological approaches, but there is no consensus on the most effective and safe combination of drugs. Network meta-analyses (NMA) can comprehensively evaluate multiple treatments for AR.
Methods
This study will search PubMed (via MEDLINE), Cochrane Library, EMBASE, and Web of Science without language or time limitations for randomised controlled trials (RCTs) that identify the combined use of hormonal drugs or antihistamines for the treatment of AR in adults and adolescents. The primary outcomes of interest are the mean change (am.+pm.) in Reflective Total Nasal Symptom Score (rTNSS) from baseline and total adverse effects. Our findings will be presented in a narrative synthesis, and where possible, we will conduct pairwise or Bayesian network meta-analyses with surface under the cumulative ranking curve analyses. We will test different statistical methods and models. Dichotomous outcomes will be reported as odds ratios, while continuous data will be recorded as mean differences with a 95% confidence interval or credibility interval. To assess the quality of the trials, we will use the Risk of Bias 2.0 tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will evaluate the confidence of the evidence.
Discussion
This systematic review and NMA will provide a comprehensive review of the efficacy and safety of combined pharmacological therapies for treating allergic rhinitis in adults and adolescents. The findings of this study will be better equipped to make informed treatment decisions for patients with allergic rhinitis and aid in the development of evidence-based practice guidelines for the optimal management of this common condition.
Systematic review registration
PROSPERO CRD42023398953.