Verapamil Improves Treatment of Severe Chronic Rhinosinusitis

A drug used to treat cardiovascular disease and cluster headaches improved symptoms in patients with chronic rhinosinusitis (CRS) with nasal polyps.

CRS can significantly impact a patient’s quality of life, often causing breathing difficulty due to obstructed nasal and sinus passages. The presence of nasal polyps is a particularly severe characteristic of the disease.

Prior studies have shown that P-glycoprotein is overexpressed in the nasal lining of patients with CRS with nasal polyps. In a study published in theJournal of Allergy and Clinical Immunology: In Practice, investigators examined the effects of verapamil, a first-generation inhibitor that blocks P-glycoprotein.

“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 hypersecretion of inflammation cytokines,” said senior author Benjamin S. Bleier, MD.

In the randomized, double-blind, placebo-controlled clinical trial, investigators examined the use of low-dose verapamil in 18 patients with CRS with nasal polyps.

The results of the study showed that patients in the verapamil arm demonstrated improved outcomes compared to individuals in the placebo arm. However, the efficacy of verapamil was significantly limited among patients with higher body mass indices.

“Verapamil is a first-generation inhibitor that is well-established in blocking P-glycoprotein,” Bleier said. “In some patients with CRS with nasal polyps, we saw a dramatic improvement in their symptom scores.

“Chronicrhinosinusitiswith nasal polyps is among our most challenging diagnoses to treat, because these patients essentially have chronic, lifelong inflammation that needs chronic, lifelong treatment. We observed no significant [adverse events] 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.”

The authors noted that future studies will examine whether a higher dose of verapamil would be needed for certain patients. Verapamil represents a promising novel therapy for the treatment of CRS with nasal polyps.