Treatment with verapamil successfully improved symptoms of chronic rhinosinusitis with nasal polyps.
Patients with severe chronic rhinosinusitis and nasal polyps were observed to have improved symptoms after treatment with verapamil, which is used to treat migraines and heart disease.
A study published by the Journal of Allergy and Clinical Immunology: In Practice was the first to evaluate treatment for chronic rhinosinusitis by blocking the P-glycoprotein, which is located in the nasal lining. The research team previously identified the role of the overexpressed glycoprotein in severe cases of chronic rhinosinusitis (CRS) with nasal polyps.
"Recently, we became aware that some of the inflammation in CRS with nasal polyps is generated by the nasal lining itself, when a particular protein pump (P-glycoprotein) is overexpressed and leads to the hyper-secretion of inflammatory cytokines," said senior author Benjamin S. Bleier, MD. "Verapamil is a first-generation inhibitor that is well-established in blocking P-glycoprotein. In some patients with CRS with nasal polyps, we saw dramatic improvement in their symptom scores."
CRS is known to impact quality of life since patients may not be able to sleep or breathe easily due to obstructions in the nasal and sinus passages. Patients can also experience facial tenderness, especially near the sinus cavities. The development of nasal polyps suggests a more advanced disease state, and makes breathing even more difficult.
Current treatment options, such as steroid use, can cause serious adverse events without curing the underlying cause of the condition, according to the study.
Due to prior findings that patients with CRS and nasal polyps have an overexpression of P-glycoprotein, the authors conducted a clinical trial to determine whether low-dose verapamil would be an effective treatment. Included in the study were 18 patients with CRS and nasal polyps.
The investigators discovered that patients receiving treatment with verapamil had significantly improved outcomes compared with placebo groups.
Interestingly, the authors found that patients with high body mass indexes tended not to respond as well to the low-dose treatment. This suggests that some patients may require higher doses of verapamil for adequate treatment, according to the study.
"Chronic rhinosinusitis with nasal polyps is among our most challenging diagnoses to treat, because these patients essentially have chronic, lifelong inflammation that needs chronic, lifelong treatment," Dr Bleier concluded. "We observed no significant side effects at the doses we used, and we are very encouraged by the results of this first step toward a more targeted therapy for our patients."