Saline Nasal Spray as Effective as Medicated Sprays in Certain Patients

Nasal cavity hydration may be an important factor preventing nosebleeds in patients with hemorrhagic telangiectasia.

A saline placebo proved to be the most effective therapy to treat chronic nosebleeds, a recent study found.

A twice-daily dose of a saline solution into the nasal cavity could prevent nosebleeds as safely and effectively as medicated solutions in certain patients. The saline solution could potentially offer benefits to patients with hemorrhagic telangiectasia (HHT), according to a study published in the Journal of the American Medical Association.

“This research highlights that there could be a benefit even in the simplest of interventions,” said corresponding author Kevin Whitehead, MD, FAHA. “No drug proved to be any better than the saline placebo, but the majority of patients improved over the course of treatment, even those using saline.”

Patients with hemorrhagic telangiectasia may have nose bleeds occurring from once a week to 2 per day. A proven treatment for the condition is to surgically seal the nose shut, which can severely affect quality-of-life, among other things.

To treat this problem, some physicians have turned to off-label prescribing. In the phase 2 North American Study of Epistaxis in HHT (NOSE) clinical trial, researchers analyzed how 3 of these off-label treatments performed.

Included in the study were 121 patients with hemorrhagic telangiectasia randomized to receive treatment with 1 of 3 drugs (bevacizumab, estriol, and tranexamic acid), or a saline placebo.

Patients sprayed the treatment into their nasal cavity twice per day for 12 weeks and logged the amount of bloody noses they experienced, how long they lasted, and their symptoms, such as severity of nosebleeds. They were also assigned a composite score of 0 to 10, with 10 being the most severe, assessing the severity of their condition.

Researchers found that all treatments lowered the patients’ severity scores and positive changes were described, regardless of the drug used or if they received the placebo.

“The results suggest that medicines that people all over the world have used appear to have no benefit over plain saline,” said senior author James Gossage, MD.

These findings suggest that hydration from nasal spray, or even saline, could prevent nosebleeds since the risk increases with dryness. However, researchers said the placebo effect may have taken place, and they cannot rule that out as a possibility.

Some of the drugs may also work more effectively if taken at a higher dose, or applied through a method that allows better adherence to the nasal cavity, according to the study. The researchers plan to recommend saline nasal spray over medicated sprays to their patients with HHT.

“We stress the importance of hydration,” said Dr Whitehead. “We tell them that something as simple as a morning and night saline spray could offer them some benefit.”

Researchers said they have not tested the saline solution in other patients, but it may offer benefits to patients with common nosebleeds as well.

“There are no data for extrapolating these results to patients with nosebleeds who don't have HHT,” Dr Gossage concluded. “But certainly it's an easy thing to try.”