Sarah Mitchell1, Maria-Magdalena Balp2, Miny Samuel1, Doreen McBride1, Marcus Maurer3. 1. RTI Health Solutions, Manchester, UK. 2. Novartis Pharma AG, Basel, Switzerland. 3. Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité, Universitätsmedizin Berlin, Berlin, Germany.
Abstract
BACKGROUND: Patients with chronic spontaneous urticaria (CSU) are sometimes unresponsive to nonsedating, second-generation, H1 antihistamines; this study summarizes published clinical evidence for patients who remain symptomatic despite treatment. OBJECTIVE: To evaluate, via a systematic literature review, clinical evidence of management strategies for patients with CSU who remain symptomatic despite approved use of nonsedating H1 antihistamines. METHODS: Using a prespecified protocol, we searched MEDLINE, Embase, the Cochrane Library (1 January 1960-20 December 2011), and published conference abstracts (2010-2012). Rigorous criteria identified trials in patients with CSU who had a history of inadequate response to previous treatment or had used combination treatments. Trials evaluating treatment-naïve patients or first-line therapies were excluded. RESULTS: Qualitative data synthesized from 26 randomized, controlled trials, four prospective studies, and one retrospective study showed cyclosporine, desloratadine plus dapsone or dipyridamole, montelukast, and omalizumab reduced urticaria activity scores, weals, and pruritus, versus placebo. Optimal treatment doses and durations were unclear due to varying trial durations, outcome measurement scales, and assessment timings. No safety concerns were reported. CONCLUSIONS: This review confirms that available evidence to guide treatment choice for patients with CSU with inadequate response to H1 antihistamines varies in quality. Further research is warranted due to low-quality trials with methodological and reporting limitations.
BACKGROUND:Patients with chronic spontaneous urticaria (CSU) are sometimes unresponsive to nonsedating, second-generation, H1 antihistamines; this study summarizes published clinical evidence for patients who remain symptomatic despite treatment. OBJECTIVE: To evaluate, via a systematic literature review, clinical evidence of management strategies for patients with CSU who remain symptomatic despite approved use of nonsedating H1 antihistamines. METHODS: Using a prespecified protocol, we searched MEDLINE, Embase, the Cochrane Library (1 January 1960-20 December 2011), and published conference abstracts (2010-2012). Rigorous criteria identified trials in patients with CSU who had a history of inadequate response to previous treatment or had used combination treatments. Trials evaluating treatment-naïve patients or first-line therapies were excluded. RESULTS: Qualitative data synthesized from 26 randomized, controlled trials, four prospective studies, and one retrospective study showed cyclosporine, desloratadine plus dapsone or dipyridamole, montelukast, and omalizumab reduced urticaria activity scores, weals, and pruritus, versus placebo. Optimal treatment doses and durations were unclear due to varying trial durations, outcome measurement scales, and assessment timings. No safety concerns were reported. CONCLUSIONS: This review confirms that available evidence to guide treatment choice for patients with CSU with inadequate response to H1 antihistamines varies in quality. Further research is warranted due to low-quality trials with methodological and reporting limitations.
Authors: Jonathan Graham; Doreen McBride; Donald Stull; Anna Halliday; Stamatia Theodora Alexopoulos; Maria-Magdalena Balp; Matthew Griffiths; Ion Agirrezabal; Torsten Zuberbier; Alan Brennan Journal: Pharmacoeconomics Date: 2016-08 Impact factor: 4.981
Authors: Victor D Mandel; Mario B Guanti; Serena Liberati; Antongiulio Demonte; Giovanni Pellacani; Patrizia Pepe Journal: Dermatol Ther (Heidelb) Date: 2018-05-16