Abstract
Introduction
The objective of this prospective, multicenter, parallel-group, non-interventional clinical trial (NIT) was to characterize the effectiveness of a treatment with the phytomedicines ELOM-080 and BNO 1016 in patients with acute rhinosinusitis (ARS).
Methods
A total of 228 patients suffering from ARS took part in this NIT and were treated for a maximum of 14 days with either BNO 1016 or ELOM-080. Focus was on improvement of rhinosinusitis-associated pain/discomfort and nasal congestion in real-life conditions of primary care setting, as assessed by numeric and verbal rating scale, and five-point Likert scale.
Results
The course of the key ARS symptom facial pain demonstrated a faster recovery in patients with ELOM-080, when compared to BNO 1016. ELOM-080 tended to be superior for several ancillary criteria and induced significantly higher patient satisfaction with regard to the improvement of feeling of general illness. Physicians assessed both products to be very effective and well tolerated. Adverse drug reactions classified as gastrointestinal disorders occurred in both groups to a comparable extent.
Conclusion
This trial demonstrated comparable effectiveness of a therapy of ARS with the phytomedicines ELOM-080 and BNO 1016, although the treatment with ELOM-080 resulted in a more rapid and more complete recovery in ARS key symptoms and tended to be superior for several ancillary criteria. Both treatments were well tolerated.
Trial registration number
NIS-6471.
Funding
G. Pohl-Boskamp GmbH & Co. KG.
Similar content being viewed by others
References
Fokkens WJ, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012;50(1):1–12.
Rosenfeld RM, et al. Clinical practice guideline (update): adult sinusitis executive summary. Otolaryngol Head Neck Surg. 2015;152(4):598–609.
Stuck B, et al. Rhinosinusitis guidelines—unabridged version: S2 guidelines from the German Society of Otorhinolaryngology, Head and Neck Surgery. HNO. 2012;60(2):141.
Hastan D, et al. Chronic rhinosinusitis in Europe—an underestimated disease. A GA2LEN study. Allergy. 2011;66(9):1216–23.
Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl. 2007;20:1–136.
Stuck BA, et al. Guideline for “rhinosinusitis”-long version: S2k guideline of the German College of General Practitioners and Family Physicians and the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery. HNO. 2018;66:38–74.
Beeh KM, et al. Effect of ELOM-080 on exacerbations and symptoms in COPD patients with a chronic bronchitis phenotype—a post hoc analysis of a randomized, double-blind, placebo-controlled clinical trial. Int J Chronic Obstr Pulm Dis. 2016;11:2877–84.
Wittig T. Myrtol standardisiert—Eine klinische Dokumentation, vol. 5. 5th ed. Hamburg: Ergebnisse-Verlag; 2010.
Federspil P, Wulkow R, Zimmermann T. Effects of standardized Myrtol in therapy of acute sinusitis—results of a double-blind, randomized multicenter study compared with placebo. Laryngorhinootologie. 1997;76(1):23–7.
Gillissen A, et al. A multi-centre, randomised, double-blind, placebo-controlled clinical trial on the efficacy and tolerability of GeloMyrtol® forte in acute bronchitis. Drug Res. 2013;63(1):19–27.
Matthys H, et al. Efficacy and tolerability of myrtol standardized in acute bronchitis. A multi-centre, randomised, double-blind, placebo-controlled parallel group clinical trial vs. cefuroxime and ambroxol. Arzneimittelforschung. 2000;50(8):700–11.
Meister R, et al. Efficacy and tolerability of myrtol standardized in long-term treatment of chronic bronchitis. A double-blind, placebo-controlled study. Study Group Investigators. Arzneimittelforschung. 1999;49(4):351–8.
Cao L, et al. Effect of Myrtol standardized on mucus hypersecretion and clearance of Pseudomonas aeruginosa in a rat model of chronic obstructive pulmonary disease. Arzneimittelforschung. 2010;61(12):685–92.
App EM. Stellenwert der Mukusclearance für das Bronchialsystem, Pathophysiologie und therapeutische Ansätze; in Entzündliche Erkrankungen des Bronchialsystems. In: Meister R, editor. Entzündliche Erkrankung des Bronchialsystems—Ergebnisse der II. Sylter Sekretolyse-Gespräche, Heidelberg: Springer; 2000. p. 27–53.
Begrow F, et al. Effect of Myrtol standardized and other substances on the respiratory tract: ciliary beat frequency and mucociliary clearance as parameters. Adv Ther. 2012;29(4):350–8.
Beuscher N, et al. Myrtol standardized (MYS) in treatment of sinusitis and bronchitis. Pharmacodynamics and pharmacokinetics. In: Abstract book of the 8th congress of the Gesellschaft für Phytotherapie. Gesellschaft für Phytotherapie; 1997.
Beuscher N, et al. Interference of myrtol standardized with inflammatory and allergic mediators. Arzneimittelforschung. 1998;48(10):985–9.
Christoph F, Kaulfers P-M, Stahl-Biskup E. In vitro evaluation of the antibacterial activity of β-triketones admixed to Melaleuca oils. Planta Med. 2001;67(08):768–71.
Grassmann J, et al. Antioxidant properties of essential oils. Possible explanations for their anti-inflammatory effects. Arzneimittelforschung. 2000;50(2):135–9.
Rantzsch U, et al. Anti-inflammatory effects of myrtol standardized and other essential oils on alveolar macrophages from patients with chronic obstructive pulmonary disease. Eur J Med Res. 2009;14(4):205–9.
Kaschke O, Behrbohm H, Sydow K. The influence of a secretolytic drug on mucociliary clearance of the maxillary sinus. J Rhinol. 1997;4(1):29–33.
Lai Y, et al. In vitro studies of a distillate of rectified essential oils on sinonasal components of mucociliary clearance. Am J Rhinol Allergy. 2014;28(3):244–8.
Li YY, et al. Myrtol standardized affects mucociliary clearance. Int Forum Allergy Rhinol. 2017;7(3):304–11.
Jund R, Mondigler M, Steindl H, Stammer H, Bachert C. Clinical efficacy of a dry extract of five herbal drugs in acute viral rhinosinusitis. Rhinology. 2012;50(4):417–26.
Jund R, et al. Herbal drug BNO 1016 is safe and effective in the treatment of acute viral rhinosinusitis. Acta Otolaryngol. 2015;135(1):42–50.
Palm J, et al. Assessment of efficacy and safety of the herbal medicinal product BNO 1016 in chronic rhinosinusitis. Rhinology. 2017;55(2):142–51.
Ismail C. Pharmakologische Effekte von Sinupret®. HNO. 2005;53(1):38–42.
Marz RW, Ismail C, Popp MA. Profile and effectiveness of a phytogenic combination preparation for treatment of sinusitis. Wien Med Wochenschr. 1999;149(8–10):202–8.
Glatthaar-Saalmüller B, et al. Antiviral activity in vitro of two preparations of the herbal medicinal product Sinupret® against viruses causing respiratory infections. Phytomedicine. 2011;19(1):1–7.
Kreindler JL, et al. The novel dry extract BNO 1011 stimulates chloride transport and ciliary beat frequency in human respiratory epithelial cultures. Am J Rhinol Allergy. 2012;26(6):439–43.
Rossi A, et al. The novel Sinupret® dry extract exhibits anti-inflammatory effectiveness in vivo. Fitoterapia. 2012;83(4):715–20.
Seifert S, et al. The novel Sinupret® dry extract BNO 1011 inhibits paw oedema development in vivo and inflammatory mediator release in vitro. Planta Med. 2012;78(11):PD107.
Antunes MB, Cohen NA. Mucociliary clearance—a critical upper airway host defense mechanism and methods of assessment. Curr Opin Allergy Clin Immunol. 2007;7(1):5–10.
Bionorica, Fachinformation Sinupret extract. 2014.
Pohl-Boskamp, Fachinformation GeloMyrtol/GeloMyrtol forte. 2014.
Passali D, et al. A prospective open-label study to assess the efficacy and safety of a herbal medicinal product (Sinupret) in patients with acute rhinosinusitis. ORL J Otorhinolaryngol Relat Spec. 2015;77(1):27–32.
Bischoff I, Zündorf I, Fürst R. TNF-α as crucial inflammatory mediator. PHARMAKON. 2017;5(5):337–42.
Sedger LM, McDermott MF. TNF and TNF-receptors: from mediators of cell death and inflammation to therapeutic giants—past, present and future. Cytokine Growth Factor Rev. 2014;25(4):453–72.
Tesche S, et al. The value of herbal medicines in the treatment of acute non-purulent rhinosinusitis. Results of a double-blind, randomised, controlled trial. Eur Arch Otorhinolaryngol. 2008;265(11):1355–9.
Guo R, Canter PH, Ernst E. Herbal medicines for the treatment of rhinosinusitis: a systematic review. Otolaryngol Head Neck Surg. 2006;135(4):496–506.
Pfaar O, et al. Cyclamen europaeum nasal spray, a novel phytotherapeutic product for the management of acute rhinosinusitis: a randomized double-blind, placebo-controlled trial. Rhinology. 2012;50(1):37–44.
Bachert C, et al. Treatment of acute rhinosinusitis with the preparation from Pelargonium sidoides EPs 7630: a randomized, double-blind, placebo-controlled trial. Rhinology. 2009;47(1):51.
Timmer A, et al. Pelargonium sidoides extract for treating acute respiratory tract infections. Cochrane Database Syst Rev. 2013;2013(10):Cd006323.
Hansen JG. Acute rhinosinusitis (ARS). Diagnosis and treatment of adults in general practice. Dan Med J. 2014;61(2):B4801.
Williams JW Jr, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. 2000;2000(2):Cd000243.
Mann W, Jonas I. A study of spontaneous cure of sinusitis (author’s transl). HNO. 1981;29(3):92–4.
van Buchem FL, et al. Primary-care-based randomised placebo-controlled trial of antibiotic treatment in acute maxillary sinusitis. Lancet. 1997;349(9053):683–7.
Acknowledgements
The authors would like to thank all patients that contributed to this trial and the investigators at the 34 study centers for including patients in compliance with the observation plan of the non-interventional study. The authors also would like to thank the independent contract research organization (CRO) responsible for conducting and reporting the study (SocraTec R&D GmbH, Oberursel, Germany).
Funding
This study and the journal’s article processing charges were supported by a grant from G. Pohl-Boskamp GmbH & Co. KG.
Authorship
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.
Authors Contribution
SG, ENT specialist, was responsible for overseeing the entire study including the final publication and provided medical and scientific advice for writing the publication manuscript. KR was involved in drafting the manuscript, revising it critically for important intellectual content, ensuring that questions related to accuracy and integrity of the work are resolved. HC provided medical and scientific advice for the publication manuscript.
Disclosures
Kristina Röschmann is employed by G. Pohl-Boskamp GmbH & Co. KG. Stefan Gottschlich and Henning Candler have nothing to disclose.
Compliance with Ethics Guidelines
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Data Availability
The data sets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Author information
Authors and Affiliations
Corresponding author
Additional information
Enhanced digital content
To view enhanced digital content for this article go to https://doi.org/10.6084/m9.figshare.6445160.
Rights and permissions
About this article
Cite this article
Gottschlich, S., Röschmann, K. & Candler, H. Phytomedicines in Acute Rhinosinusitis: A Prospective, Non-interventional Parallel-Group Trial. Adv Ther 35, 1023–1034 (2018). https://doi.org/10.1007/s12325-018-0736-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12325-018-0736-7