Comparative effectiveness of non-sedating antihistamines for patients
with chronic spontaneous urticaria: a systematic review and network
Background Chronic spontaneous urticaria (CSU) is a kind of urticaria
that occurs independently without any exogenous stimulus. Non-sedating
H1-antihistamine is recognized as the first-line treatment option for
CSU. Objective To access the comparative efficacy of non-sedating
antihistamines in the treatment of CSU and to provide a relative ranking
of these treatments. Methods We enrolled randomized controlled trials
(RCTs) that compared a single non-sedating antihistamine with placebo or
anther single non-sedating antihistamine through searching databases:
CENTRAL, MEDLINE, and EMBASE; as well as the trial registries: ISRCTN,
ClinicalTrials. gov, ChiCTR, and ICTRP, etc. Two investigators evaluated
the eligibility, extracted the data, and assess the risk of bias of
included trials independently. A Bayesian network meta-analysis was
performed. Results We identified 42 RCTs with 8164 participants.
Twenty-six studies were included for the further network meta-analysis.
The odds ratio (95% credible intervals) of total overall symptoms
relief after 4-week treatment, the top three ordered from the most to
least effective non-sedating antihistamines were: loratadine 15.0 (2.9,
14.0), mizolastine 14.0 (2.9, 75.0), cetirizine 13.0 (4.4, 44.0).
Conclusions All enrolled non-sedating antihistamines were found to show
superiority over placebo in clinical outcomes in patients with CSU.
Loratadine, mizolastine, and cetirizine are the most efficacious drugs.
More head-to-head trials in a large number of patients are needed to
perform in the future.