Shah B, Dhoot D, Choudhary A, Jangid N, Mistry D, Shah S, Kamat S, Barkate H
Clin Cosmet Investig Dermatol. 2022 Feb 18;15:261-270. doi: 10.2147/CCID.S350122.
Chronic spontaneous urticaria (CSU) is a common skin condition associated with angioedema, wheals, or both. Although second-generation antihistamines (SGAH) are first-line drugs in CSU, half of the patients do not respond to them. Guidelines recommendation for these patients is to up-dose SGAH or combine different antihistamines. The objective of this study was to examine the effectiveness and tolerability of up-dosing of bilastine and fexofenadine up to two times and combination of non-sedating second-generation antihistamines; levocetirizine and first-generation antihistamine; and hydroxyzine in patients with CSU.
This was a comparative, three-arm study, which randomized CSU participants to receive standard dose of either bilastine, fexofenadine, or levocetirizine for 2 weeks. After 2 weeks of treatment, non-responders received double dose of either bilastine or fexofenadine, while hydroxyzine 25 mg once daily was added in the levocetirizine group. Participants were assessed for better outcomes in CSU, quality of life, and somnolence.
The study included 110 participants with CSU. At the end of 4 weeks, 33/39, 26/35, and 22/36 patients in the bilastine, fexofenadine, and levocetirizine groups indicated improvement in urticaria symptoms. At week 2, the urticaria activity score improvement showed no statistical difference between any of the groups; however, at week 4, there was a statistical difference between the bilastine and levocetirizine groups (p<0.05). Somnolence was significantly lower in the bilastine group (p<0.05). Bilastine was statistically significant (p<0.05) in the improvement of quality of life as compared to both groups. There was no report of major adverse events during the study period; however, bilastine was related to significantly lower levels of adverse events compared to levocetirizine (p<0.05).
In conclusion, a two-fold up-dosing of bilastine improves CSU symptoms with no changes in safety as compared to two-fold up-dosing of fexofenadine and combination of first- and second-generation antihistamines.
