Azelastine 0.15% vs. mometasone furoate for perennial allergic rhinitis: 12-month study

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Created On: 10/09/2026

Intranasal corticosteroids (INCS) are widely used for moderate-to-severe allergic rhinitis, while azelastine 0.15% is an established intranasal antihistamine option.

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Key take away

Azelastine provides quality-of-life improvement comparable to mometasone furoate over 12 months in adults with perennial allergic rhinitis.

Background

Intranasal corticosteroids (INCS) are widely used for moderate-to-severe allergic rhinitis, while azelastine 0.15% is an established intranasal antihistamine option. However, long-term comparative evidence on quality of life in perennial allergic rhinitis (PAR) is limited. This study compared azelastine 0.15% with mometasone furoate over 1 year.

Method

This open-label, active-controlled, 1-year study was conducted at 57 centres in the United States. Adults suffering from PAR were randomized 2:1 to azelastine 0.15% (1,644 μg/day; twice daily) or mometasone furoate (200 μg/day; once daily). Quality of life was assessed using the 28-item Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). The intent-to-treat population was utilized for efficacy assessment.

Result

Of 703 randomized patients, 687 (97.7%) were included in the intent-to-treat population. Mean treatment exposure was 270.7 days. RQLQ scores considerably improved from baseline with both treatments (P<0.001). The overall improvement was similar with azelastine and mometasone furoate (Table 1).

Although mometasone furoate showed a small statistical advantage at month 12 (P=0.037), the difference was below the minimal clinically important difference of 0.5 units. Azelastine 0.15% was well-tolerated over 12 months. Common adverse events were dysgeusia (13.3%), nasal discomfort (9.9%), sinusitis (9.4%), upper respiratory tract infection (9.2%), epistaxis (9.2%), nasopharyngitis (9.2%), and headache (8.8%). No nasal mucosal ulcerations or septal perforations were reported.

Conclusion

Azelastine 0.15% demonstrated sustained quality-of-life improvement comparable to mometasone furoate over 12 months, supporting its role as an alternative treatment for PAR.