Efficacy and safety of corticosteroids in the management of chronic rhinosinusitis: A systematic review and meta-analysis of randomized and non-randomized studies

OBJECTIVE: To evaluate the efficacy and safety of corticosteroids in Chronic Rhinosinusitis (CRS), focusing on health-related quality of life, disease severity, systemic steroid-sparing effects, and Serious Adverse Events (SAEs). METHODS: Following PRISMA 2020 guidelines, PubMed, Web of Science, and Cochrane CENTRAL were systematically searched for randomized and non-randomized studies in adults with CRS. Outcomes included SNOT-22 scores, endoscopic findings, systemic corticosteroid use, and SAEs. Risk of bias was assessed using RoB 2.0 and Newcastle-Ottawa Scale. Meta-analyses employed random-effects models, with pooled estimates reported as Mean Differences (MD) or Odds Ratios (OR) and 95% Confidence Intervals (95% CI). RESULTS: Eleven studies (3,542 patients) were included. Corticosteroid therapy significantly improved SNOT-22 scores (MD = -16.00, 95% CI: -18.91 to -13.09, p < 0.0001; I² = 90.3%) and endoscopic outcomes (MD = -2.32, 95% CI: -2.71 to -1.94, p < 0.001; I² = 61.2%). Local corticosteroids reduced systemic steroid dependence (OR = 0.30, 95% CI: 0.27-0.34, p < 0.0001; I² = 0%). No statistically significant increase in SAEs was observed (OR = 1.47, 95% CI: 0.44-4.93, p = 0.9848; I² = 0%). Heterogeneity was high for SNOT-22 and endoscopic outcomes, but funnel plots showed no major publication bias. CONCLUSION: Corticosteroids improve quality of life and objective disease measures in CRS while reducing reliance on systemic steroids, with no significant increase in SAEs. Future studies should compare delivery modalities, assess long-term safety, and explore biomarker-guided strategies.