Steroid Treatment for Elimination of Rebound Obstruction From Intranasal Decongestants

NCT ID: NCT07168148

Last Updated: 2025-11-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-11-10

Study Completion Date

2026-12-31

Brief Summary

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This prospective, virtually administered trial conducted throughout the United States aims to evaluate a standardized protocol including the serial dilution of topical decongestants with concurrent topical steroids (triamcinolone), for elimination of dependence on topical decongestants.

Detailed Description

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Participants will begin the trial by providing their average daily usage of oxymetazoline. They will then be stratified according to this usage and will be placed into a titration schedule. In the first week of the trial they will continue their usage of oxymetazoline plus twice daily triamcinolone intranasal spray. Continuing twice daily triamcinolone intranasal spray, the oxymetazoline dosage will be decreased each week until it matches the triamcinolone frequency. Each week following this point the subjects will continue with a mixture of different concentrations of oxymetazoline till complete elimination.

The maximum treatment time for participants who start the trial in the highest frequency oxymetazoline use group (greater than or equal to 5 times per day) would be 8 weeks.

After a week on a given titration level, they will be assessed for severity of nasal obstruction and, if controlled, they will progress to the next titration.

Conditions

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Nasal Obstruction Chronic Rhinitis

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

prospective virtually administered
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Titration

Participants will begin the trial by providing their average daily usage of oxymetazoline.

They will then be stratified according to this usage and placed into a titration schedule. After a week on a given titration level, they will be assessed for severity of nasal obstruction and, if controlled, they will progress to the next lower titration level.

Participants with twice daily use, will then be placed in a titration schedule for oxymetazoline concentration which will stop when the oxymetazoline concentration is set to zero.

Group Type EXPERIMENTAL

Oxymetazoline + Triamcinolone

Intervention Type DRUG

Participants will be stratified according to this usage and placed into a titration schedule.

* Titration 1: 0.05% 5x/day,
* Titration 2: 0.05% 4x/day,
* Titration 3: 0.05 3x/day,
* Titration 4: 0.05% 2x/day.

Participants with twice daily use, will then be placed in a titration schedule for oxymetazoline concentration which will stop when the oxymetazoline concentration is set to zero.

* Titration 5: 0.0375% Afrin/Nasacort 2x/day,
* Titration 6: 0.025% Afrin/Nasacort 2x/day,
* Titration 7: 0.0125% Afrin/Nasacort 2x/day,
* Titration 8: 0.0% Afrin/Nasacort 2x/day.

Interventions

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Oxymetazoline + Triamcinolone

Participants will be stratified according to this usage and placed into a titration schedule.

* Titration 1: 0.05% 5x/day,
* Titration 2: 0.05% 4x/day,
* Titration 3: 0.05 3x/day,
* Titration 4: 0.05% 2x/day.

Participants with twice daily use, will then be placed in a titration schedule for oxymetazoline concentration which will stop when the oxymetazoline concentration is set to zero.

* Titration 5: 0.0375% Afrin/Nasacort 2x/day,
* Titration 6: 0.025% Afrin/Nasacort 2x/day,
* Titration 7: 0.0125% Afrin/Nasacort 2x/day,
* Titration 8: 0.0% Afrin/Nasacort 2x/day.

Intervention Type DRUG

Other Intervention Names

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Afrin + Nasacort

Eligibility Criteria

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Inclusion Criteria

2\) have a history of chronic nasal obstruction 3) at least daily topical decongestant usage for at least 3 months 4) ability to read, write, and understand English.

Exclusion Criteria

1. Any history of sinonasal mass/tumor
2. Any history of nasal polyps
3. Septal perforation
4. A diagnosis of one of the following conditions:

1. eosinophilic granulomatosis with polyangiitis
2. granulomatosis with polyangiitis
5. Any current intranasal drug use such as cocaine.
6. If they are currently using or have used intranasal steroid medications (oral or nasal) besides oxymetazoline for the past month.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Washington University School of Medicine

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nyssa Farrell, MD

Role: PRINCIPAL_INVESTIGATOR

Washington University School of Medicine

Locations

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Washington University

St Louis, Missouri, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Nyssa Farrell, MD

Role: CONTACT

314-362-7509

Sara Kukuljan

Role: CONTACT

314-362-7563

Facility Contacts

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Sara Kukuljan

Role: primary

314-362-7563

Lucas Cruz, BA

Role: backup

314-362-0549

References

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Lipan MJ, Most SP. Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg. 2013 Sep-Oct;15(5):358-61. doi: 10.1001/jamafacial.2013.344.

Reference Type BACKGROUND
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Graf P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med. 2005;4(1):21-9. doi: 10.2165/00151829-200504010-00003.

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Settipane RA, Charnock DR. Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol. 2007;19:23-34.

Reference Type BACKGROUND
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Mehuys E, Gevaert P, Brusselle G, Van Hees T, Adriaens E, Christiaens T, Van Bortel L, Van Tongelen I, Remon JP, Boussery K. Self-medication in persistent rhinitis: overuse of decongestants in half of the patients. J Allergy Clin Immunol Pract. 2014 May-Jun;2(3):313-9. doi: 10.1016/j.jaip.2014.01.009. Epub 2014 Mar 29.

Reference Type BACKGROUND
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LAKE CF. Rhinitis medicamentosa. Proc Staff Meet Mayo Clin. 1946 Sep 18;21(19):367-71. No abstract available.

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Feinberg AR, Feinberg SM. The "nose drop nose" due to oxymetazoline (Afrin) and other topical vasoconstrictors. IMJ Ill Med J. 1971 Jul;140(1):50-2. No abstract available.

Reference Type BACKGROUND
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Hallen H, Enerdal J, Graf P. Fluticasone propionate nasal spray is more effective and has a faster onset of action than placebo in treatment of rhinitis medicamentosa. Clin Exp Allergy. 1997 May;27(5):552-8.

Reference Type BACKGROUND
PMID: 9179430 (View on PubMed)

Ferguson BJ, Paramaesvaran S, Rubinstein E. A study of the effect of nasal steroid sprays in perennial allergic rhinitis patients with rhinitis medicamentosa. Otolaryngol Head Neck Surg. 2001 Sep;125(3):253-60. doi: 10.1067/mhn.2001.117717.

Reference Type BACKGROUND
PMID: 11555762 (View on PubMed)

Scadding GK. Rhinitis medicamentosa. Clin Exp Allergy. 1995 May;25(5):391-4. doi: 10.1111/j.1365-2222.1995.tb01068.x. No abstract available.

Reference Type BACKGROUND
PMID: 7553240 (View on PubMed)

Vaidyanathan S, Williamson P, Clearie K, Khan F, Lipworth B. Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion. Am J Respir Crit Care Med. 2010 Jul 1;182(1):19-24. doi: 10.1164/rccm.200911-1701OC. Epub 2010 Mar 4.

Reference Type BACKGROUND
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Graedon, Terry. "How to Beat Nose Spray Dependence One Nostril at a Time." Https://Www.Peoplespharmacy.Com/, The People's Pharmacy, 27 Mar. 2023, www.peoplespharmacy.com/articles/how-to-beat-nose-spray-dependence-one- nostril-at-a-time.

Reference Type BACKGROUND

Afrin Addicts. [ca. 2024]. In Facebook [Group page]. Retrieved September 4, 2024, from https://www.facebook.com/groups/1551311815137595

Reference Type BACKGROUND

Park SSE, Barmettler A. Vision Loss Secondary to Facial and Periorbital Steroid Injection: A Systematic Review. Ophthalmic Plast Reconstr Surg. 2021 Nov-Dec 01;37(6):511-521. doi: 10.1097/IOP.0000000000001910.

Reference Type BACKGROUND
PMID: 33481540 (View on PubMed)

Elwany SS, Stephanos WM. Rhinitis medicamentosa. An experimental histopathological and histochemical study. ORL J Otorhinolaryngol Relat Spec. 1983;45(4):187-94. doi: 10.1159/000275642.

Reference Type BACKGROUND
PMID: 6192384 (View on PubMed)

Elwany S, Abdel-Salaam S. Treatment of rhinitis medicamentosa with fluticasone propionate--an experimental study. Eur Arch Otorhinolaryngol. 2001 Mar;258(3):116-9. doi: 10.1007/s004050000309.

Reference Type BACKGROUND
PMID: 11374251 (View on PubMed)

Knipping S, Holzhausen HJ, Goetze G, Riederer A, Bloching MB. Rhinitis medicamentosa: electron microscopic changes of human nasal mucosa. Otolaryngol Head Neck Surg. 2007 Jan;136(1):57-61. doi: 10.1016/j.otohns.2006.08.025.

Reference Type BACKGROUND
PMID: 17210334 (View on PubMed)

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Reference Type BACKGROUND
PMID: 14994772 (View on PubMed)

Cam B, Sari M, Midi A, Gergin O. Xylitol treats nasal mucosa in rhinitis medicamentosa: an experimental rat model study. Eur Arch Otorhinolaryngol. 2019 Nov;276(11):3123-3130. doi: 10.1007/s00405-019-05605-3. Epub 2019 Aug 29.

Reference Type BACKGROUND
PMID: 31468129 (View on PubMed)

Suh SH, Chon KM, Min YG, Jeong CH, Hong SH. Effects of topical nasal decongestants on histology of nasal respiratory mucosa in rabbits. Acta Otolaryngol. 1995 Sep;115(5):664-71. doi: 10.3109/00016489509139384.

Reference Type BACKGROUND
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Tas A, Yagiz R, Yalcin O, Uzun C, Huseyinova G, Adali MK, Karasalihoglu AR. Use of mometasone furoate aqueous nasal spray in the treatment of rhinitis medicamentosa: an experimental study. Otolaryngol Head Neck Surg. 2005 Apr;132(4):608-12. doi: 10.1016/j.otohns.2005.01.010.

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Reference Type BACKGROUND
PMID: 20526405 (View on PubMed)

Other Identifiers

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202501224

Identifier Type: -

Identifier Source: org_study_id

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