Boston—A calcium channel blocker which has been in use for more than 50 years, first to treat hypertension and later to treat cluster headaches, now shows promise for a new indication: alleviating chronic rhinosinusitis (CRS) with nasal polyps.

An online article in the Journal of Allergy and Clinical Immunology: In Practice reports that a subset of those patients significantly improved on verapamil.

Study authors, led by researchers from Harvard Medical School and Massachusetts Eye and Ear, note that the study is the first of its kind to explore treatment for CRS by inhibiting P-glycoprotein, a protein pump within the nasal lining. The same research group previously identified that mechanism as a cause of severe cases 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,” explained senior author Benjamin S. Bleier, MD, a sinus surgeon at Massachusetts Eye and Ear and an assistant professor of otolaryngology at Harvard Medical School. “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 patients often have problems breathing or sleeping easily due to obstructed nasal and sinus passages, which strongly diminish their quality of life. Study authors point out that the presence of nasal polyps is an indicator of an especially severe presentation of the disease.

Currently, the condition is most often treated with long-term steroids, which cause hard-to-manage side effects, according to the report.

To test their theories about the presence of P-glycoprotein overexpression in the nasal lining of patients who have CRS with nasal polyp, study authors conducted a randomized, double-blind, placebo-controlled clinical trial studying the use of low-dose verapamil in 18 patients with CRS with nasal polyps.

Results indicate improved outcomes for those in the verapamil group compared to others receiving a placebo. The treatment effect was significantly limited among patients with higher body mass indices, however, and study authors say that future studies are being planned to determine if a higher dose of verapamil may be needed to be therapeutic for some patients.

“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,” Bleier emphasized. “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.”

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