***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVE MP29 - 02 ( Dymista ) , a novel intranasal formulation of azelastine hydrochloride ( AZE ) and fluticasone propionate ( FP ) , is significantly better than first-line therapy for the treatment of moderate-to-severe seasonal allergic rhinitis ( SAR ) , and is well tolerated following 52 weeks of continuous use in chronic rhinitis . The aim of this study was to evaluate the long-term efficacy of MP29 - 02 versus FP in patients with chronic rhinitis . PATIENTS AND METHODS In total , 612 chronic rhinitis patients ( perennial allergic rhinitis [ PAR ] , n = 424 ; nonallergic rhinitis , n=188 ) aged 12 years or older were enrolled into this open-label , parallel-group study and r and omized to MP29 - 02 ( 1 spray/nostril bid ) or FP nasal spray ( 2 sprays/nostril qd ) for 52 weeks . Efficacy was assessed by change from baseline in PM reflective total nasal symptom score ( rTNSS ) , time to first achieve 100 % PM rTNSS reduction from baseline , and percentage of symptom-free days in the total and PAR population s posthoc . RESULTS MP29 - 02 reduced patients ' PM rTNSS from baseline significantly more than FP , from Day 1 up to and including week 28 ( -2.88 vs -2.53 ; P = .0048 ) , with treatment difference maintained for 52 weeks . Fluctuation in significance after week 28 might be explained , at least in part , by decreasing sample size , permitted according to ICH guidelines . By Day 1 almost twice as many MP29 - 02- patients were symptom free . After 1 month , 71.1 % of MP29 - 02 patients experienced 100 % rTNSS reduction ( 60.3 % for FP ) , and did on a median of 9 days faster ( P=.0024 ) . Over 52 weeks MP29 - 02 patients experienced 8.4 % more symptom-free days ( P = .0005 ) . These results were mirrored in the PAR sub population . CONCLUSION These results confirm MP29 - 02 's wide therapeutic spectrum and assert its consistent superiority over an intranasal corticosteroid The combination of intranasal antihistamines and intranasal corticosteroids results in superior relief of  seasonal allergic rhinitis ( SAR ) symptoms compared with monotherapy . This study was design ed to evaluate the safety and efficacy of olopatadine hydrochloride nasal spray , 0.6 % ( OLO ) , administered in combination with fluticasone nasal spray , 50 micrograms ( FNS ) , relative to azelastine nasal spray , 0.1 % ( AZE ) , administered in combination with FNS in the treatment of SAR . This was a multicenter , double-blind , r and omized , parallel-group comparison of OLO + FNS versus AZE + FNS administered for 14 days to patients ≥12 years of age with histories of SAR . Efficacy assessment s recorded by patients in a daily diary included nasal symptom scores . Safety was evaluated based on adverse events ( AEs ) . Pretreatment values for reflective total nasal symptoms scores ( rTNSS ) were similar for both treatment groups . The mean ( SD ) 2-week average rTNSS was 4.28 ( 2.63 ) for OLO + FNS and 4.15 ( 2.63 ) for AZE + FNS ; these scores were not statistically different between treatment groups . No significant differences ( p > 0.05 ) between OLO + FNS and AZE + FNS were observed for the average 2-week percent changes from baseline in rTNSS or in the individual nasal symptoms ( nasal congestion , rhinorrhea , itchy nose , and sneezing ) . Compared with baseline , both groups had statistically significant improvement in rTNSS ( p < 0.05 ) . No serious AEs were reported in either group during the study period . Overall , 19 AEs were reported in the OLO + FNS group and 29 AEs were reported in the AZE + FNS group . OLO , when administered adjunctively with FNS , is effective , safe , and well-tolerated in patients with SAR BACKGROUND This study aim ed to assess the efficacy of MP-AzeFlu ( a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in a single spray ) in children with seasonal allergic rhinitis ( SAR ) and explore the importance of child symptom severity assessment in paediatric allergic rhinitis ( AR ) trials . METHODS A total of 348 children ( 4 - 11 years ) with moderate/severe SAR were r and omized into a double-blind , placebo-controlled , 14-day , parallel-group trial . Efficacy was assessed by changes from baseline in reflective total nasal symptom score ( rTNSS ) , reflective total ocular symptom score ( rTOSS ) and individual symptom scores over 14 days ( children 6 - 11 years ; n = 304 ) , recorded by either children or caregivers . To determine whether a by-proxy effect existed , efficacy outcomes were assessed according to degree of child/caregiver rating . Moreover , total Paediatric Rhinitis Quality of Life Question naire ( PRQLQ ) score was compared between the groups . RESULTS A statistically superior , clinical ly relevant efficacy signal of MP-AzeFlu versus placebo was apparent for PRQLQ overall score ( diff : -0.29 , 95 % CI -0.55 , -0.03 ; p = 0.027 ) , but not for rTNSS ( diff : -0.80 ; 95 % CI : -1.75 ; 0.15 ; p = 0.099 ) . However , as the extent of children 's self-rating increased , so too did the treatment difference between MP-AzeFlu and placebo ; MP-AzeFlu provided significantly better relief than placebo for rTNSS ( p = 0.002 ) , rTOSS ( p = 0.009 ) and each individual nasal and ocular symptom assessed ( except rhinorrhoea ; p = 0.064 ) when children mostly rated their own symptoms . CONCLUSIONS MP-AzeFlu is an effective treatment for AR in childhood . Caregivers are less able than children to accurately assess response to treatment with available tools . A simple paediatric-specific tool to assess efficacy in AR trials in children is needed BACKGROUND To our knowledge , there are no published studies that evaluated the efficacy of azelastine hydrochloride nasal spray in combination with an intranasal corticosteroid , although anecdotal reports of the use of these agents in combination are common . OBJECTIVE To determine if greater efficacy could be achieved with the intranasal antihistamine azelastine and the intranasal corticosteroid fluticasone propionate used concurrently compared with the efficacy of each agent alone . METHODS This r and omized , 2-week , multicenter , double-blind trial was conducted during the Texas mountain cedar season . After a 5-day placebo lead-in period , 151 patients with moderate to severe nasal symptoms were r and omized to treatment with the following : ( 1 ) azelastine nasal spray , 2 sprays per nostril twice daily ; ( 2 ) fluticasone nasal spray , 2 sprays per nostril once daily ; or ( 3 ) azelastine nasal spray , 2 sprays per nostril twice daily , plus fluticasone nasal spray , 2 sprays per nostril once daily . The primary efficacy variable was the change from baseline in the total nasal symptom score ( TNSS ) , consisting of sneezing , itchy nose , runny nose , and nasal congestion . RESULTS All 3 groups had statistically significant ( P < .001 ) improvements from their baseline TNSS after 2 weeks of treatment . The TNSS improved 27.1 % with fluticasone nasal spray , 24.8 % with azelastine nasal spray , and 37.9 % with the 2 agents in combination ( P < .05 vs either agent alone ) . All 3 treatments were well tolerated . CONCLUSIONS The significant improvement in the TNSS with combination therapy relative to the individual agents alone is in contrast to previously published studies that found no advantage with an oral antihistamine and an intranasal corticosteroid in combination . Azelastine nasal spray and fluticasone nasal spray in combination may provide a substantial therapeutic benefit for patients with seasonal allergic rhinitis compared with therapy with either agent alone Many patients with allergic rhinitis ( AR ) have uncontrolled symptoms despite available treatment options . This study was design ed to evaluate the efficacy and safety of MP29 - 02 ( a novel intranasal formulation of fluticasone propionate [ FP ] and azelastine [ AZ ] hydrochloride ) , compared with monotherapy with FP , AZ , and placebo sprays for the treatment of seasonal allergic rhinitis ( SAR ) . This 2-week r and omized , double-blind , placebo-controlled trial was conducted in 779 patients with moderate-to-severe SAR . Treatments were administered 1 spray/nostril twice daily in the same vehicle and delivery device . Daily doses of AZ and FP were 548 and 200 micrograms , respectively . The primary efficacy variable was the 12-hour reflective total nasal symptom score ( rTNSS ) , consisting of nasal congestion , sneezing , itchy nose , and runny nose . Secondary efficacy variables were ( 1 ) 12-hour reflective individual nasal symptom scores ; ( 2 ) onset of action ; ( 3 ) 12-hour reflective total ocular symptom score ( rTOSS ) , including itchy eyes , watery eyes , and red eyes ; and ( 4 ) the Rhinoconjunctivitis Quality of Life Question naire ( RQLQ ) overall score . MP29 - 02 significantly reduced the mean rTNSS from baseline by -5.54 points compared with FP ( -4.55 ; p = 0.038 ) , AZ ( -4.54 ; p = 0.032 ) , and placebo ( -3.03 ; p < 0.001 ) , improving the rTNSS by 39 % beyond the contribution of FP . All individual nasal symptoms contributed to the efficacy of MP29 - 02 . Onset of action was within 30 minutes . MP29 - 02 significantly improved rTOSS compared with placebo , provided a clinical ly important improvement in the overall RQLQ score , and was well tolerated . In this study , MP29 - 02 provided more complete symptom relief than two widely used first-line AR treatments and was well tolerated BACKGROUND Moderate-to-severe allergic rhinitis ( AR ) is a challenge to treat , with many patients using multiple therapies and achieving limited symptom control . More effective therapies must be developed and tested in well-controlled , r and omized , prospect i ve studies with a direct comparison to current st and ards . OBJECTIVES The aim of these studies was to investigate the efficacy of MP29 - 02 ( a novel formulation of azelastine and fluticasone propionate [ FP ] ) in patients with moderate-to-severe seasonal allergic rhinitis ( SAR ) and to compare its efficacy with 2 first-line therapies ( ie , intranasal azelastine and intranasal FP ) in this population . METHODS Three thous and three hundred ninety-eight patients ( ≥12 years old ) with moderate-to-severe SAR were enrolled into 3 multicenter , r and omized , double-blind , placebo- and active-controlled , parallel-group trials ( MP4002 [ NCT00651118 ] , MP4004 [ NCT00740792 ] , and MP4006 [ NCT00883168 ] ) . Each trial was conducted for 14 days during different allergy seasons . The primary efficacy variable was the sum of the morning and evening change from baseline in reflective total nasal symptom score ( range , 0 - 24 ) over the treatment period . Outcomes for the meta- analysis included efficacy according to disease severity and time to response in relevant responder criteria . RESULTS In the meta- analysis MP29 - 02 reduced the mean reflective total nasal symptom score from baseline ( -5.7 [ SD , 5.3 ] ) more than FP ( -5.1 [ SD , 4.9 ] , P < .001 ) , azelastine ( -4.4 [ SD , 4.8 ] , P < .001 ) , or placebo ( -3.0 [ SD , 4.2 ] , P < .001 ) . This benefit was observed from the first day of assessment , with improvement in each individual nasal symptom , even in the patients with the most severe disease . MP29 - 02 achieved response consistently days earlier and showed greater efficacy in patients with moderate-to-severe rhinitis than FP and azelastine . CONCLUSIONS MP29 - 02 represents a novel therapy that demonstrated superiority to 2 first-line therapies for AR . Patients with moderate-to-severe SAR achieved better control , and their symptoms were controlled earlier with MP29 - 02 than with recommended medications according to guidelines BACKGROUND A proof-of-concept study suggested that combination therapy with commercial azelastine hydrochloride nasal spray and fluticasone propionate nasal spray significantly improved nasal 
    Output:
    
Conclusion Current evidence supports both efficacy and superiority of combination intranasal azelastine and fluticasone in reducing patient-reported symptom scores in patients with allergic rhinitis .