Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Allergic rhinitis (AR) affects 20–30% of the Indian population, with its incidence increasing as air quality worsens. Intranasal corticosteroid-based fixed-dose combinations (FDCs) offer superior symptom control over monotherapy. Fluticasone furoate with oxymetazoline and fluticasone propionate with azelastine have each demonstrated efficacy over their individual components; however, no comparative data exist between these two regimens. <bold>Objectives:</bold> To compare the clinical efficacy, anti-inflammatory effect, medication adherence, and safety of Fluticasone furoate with oxymetazoline (once daily) versus fluticasone propionate with azelastine (twice daily) in moderate-to-severe AR over 4 weeks. <bold>Methods:</bold> This single-centre, randomized, open-label pilot study enrolled 60 patients aged 12–60 years with moderate-to-severe AR (TNSS ≥6). Patients were randomized to Group A (FF with OXY once daily, n=26) or Group B (FP with AZE twice daily, n=27). Total Nasal Symptom Score (TNSS), absolute eosinophil count (AEC), serum IgE, and medication adherence (PDC) were assessed at baseline, day 14, and day 30. Data were analyzed using two-way repeated-measures ANOVA. <bold>Results:</bold> Both groups showed a significant reduction in TNSS over time (p<0.0001; η²=0.95). A significant drug × time interaction (p=0.020) indicated faster early relief with FP with AZE, though both groups achieved near-complete resolution by day 30. AEC and serum IgE declined significantly across time points in both groups (p<0.0001) with no significant difference between groups. Medication adherence was high in both groups (Group A: 94%; Group B: 93% PDC). No adverse drug reactions were reported. <bold>Conclusion:</bold> Both FDCs demonstrated significant and comparable efficacy in moderate-to-severe AR. FP with AZE provided faster early symptom onset, while FF with OXY offered the advantage of once-daily dosing with high adherence. Treatment selection should be individualized based on patient preference and clinical profile. </p>