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Comparative efficacy of non-sedating antihistamine updosing in patients with chronic urticaria.

Sánchez-Borges M, Ansotegui I, Jimenez JM, Rojo MI, Serrano C, Yañez A - World Allergy Organ J (2014)

View Article: PubMed Central - PubMed

Affiliation: Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad and Clínica El Avila, 6a transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060 Venezuela.

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Urticaria and angioedema lasting more than 6 weeks have been designated as chronic urticaria (CU)... It encompasses two major subtypes: chronic spontaneous urticaria (CSU) (previously known as chronic idiopathic urticaria) (CIU) and chronic inducible urticaria... In patients that do not respond to standard doses, the next step in guideline-based therapy is to increase AH doses up to 4 times... Investigations assessing the response to various NSAHs have demonstrated that up-dosing is significantly more effective in reducing symptoms of CU than standard-dose treatment... A literature search of PubMed/MEDLINE looking specifically at the studies that investigated the effects of increased doses of NSAHs in patients with all subtypes of CU was conducted... A number of publications that evaluated different NSAHs in increasing doses have clearly demonstrated that a higher proportion of patients previously uncontrolled exhibit significant improvements of their symptoms after going through this approach... It is important to mention that these enhanced results have generally been accomplished without compromising patient’s safety, since no increased rates of side effects, including somnolence, have been observed... The mechanisms explaining patient’s benefits from up-dosing are not completely understood, but increased in vivo receptor occupancy, and effects of antihistamines on additional receptors have been proposed... In a previous review article we had proposed that favorable responses to high doses of NSAHs in patients with CU were not uniformly observed, and it was likely that there would be dissimilar results when outcomes from different studies were compared... Somnolence, drowsiness, or sedation was uncommon, although for patients treated with rupatadine 20 mg somnolence was observed more often than in the placebo group in two studies... The utilization of increased doses of desloratadine, levocetirizine, and bilastine has not been associated with adverse effects... The results presented in this paper must be taken into consideration cautiously because there is a large heterogeneity between studies included in regard to various aspects of the investigation such as the subtype of chronic urticaria under study, duration of the treatment, study design, drug doses, and primary outcomes... We can conclude that increased doses of NSAHs show an improved efficacy in patients with CU who do not respond to approved doses.

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Related in: MedlinePlus

Efficacy of increased doses of nonsedating antihistamines in patients with chronic urticaria. A) According to mean pruritus score (MPS). *Fexofenadine 120 mg vs Fexofenadine 240 mg p = 0.01, ¶ Fexofenadine 120 mg vs Rupatadine 20 mg p = 0.0001, ♦ Fexofenadine 240 mg vs Rupatadine 20 mg p = 0.03. B) According to percentage of symptom-free patients. * Desloratadine 10 mg vs Desloratadine 120 mg, Desloratadine 10 mg vs Levocetirizine 10 mg, Desloratadine 10 mg vs Levocetirizine 20 mg, Desloratadine 20 mg vs Levocetirizine 10 mg, Desloratadine 20 mg vs Levocetirizine 20 mg, Levocetirizine 10 mg vs Levocetirizine 20 mg, Bilastine 40 mg vs Bilastine 80 mg p n.s. ¶ Desloratadine 10 mg vs Bilastine 40 mg p = 0.006. ♦ Desloratadine 10 mg vs Bilastine 80 mg p = 0.002. ♠ Desloratadine 20 mg vs Bilastine 40 mg, Desloratadine 20 mg vs Bilastine 80 mg, Levocetirizine 10 mg vs Bilastine 40 mg p = 0.02. ♣ Levocetirizine 10 mg vs Bilastine 80 mg p = 0.01.
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Fig1: Efficacy of increased doses of nonsedating antihistamines in patients with chronic urticaria. A) According to mean pruritus score (MPS). *Fexofenadine 120 mg vs Fexofenadine 240 mg p = 0.01, ¶ Fexofenadine 120 mg vs Rupatadine 20 mg p = 0.0001, ♦ Fexofenadine 240 mg vs Rupatadine 20 mg p = 0.03. B) According to percentage of symptom-free patients. * Desloratadine 10 mg vs Desloratadine 120 mg, Desloratadine 10 mg vs Levocetirizine 10 mg, Desloratadine 10 mg vs Levocetirizine 20 mg, Desloratadine 20 mg vs Levocetirizine 10 mg, Desloratadine 20 mg vs Levocetirizine 20 mg, Levocetirizine 10 mg vs Levocetirizine 20 mg, Bilastine 40 mg vs Bilastine 80 mg p n.s. ¶ Desloratadine 10 mg vs Bilastine 40 mg p = 0.006. ♦ Desloratadine 10 mg vs Bilastine 80 mg p = 0.002. ♠ Desloratadine 20 mg vs Bilastine 40 mg, Desloratadine 20 mg vs Bilastine 80 mg, Levocetirizine 10 mg vs Bilastine 40 mg p = 0.02. ♣ Levocetirizine 10 mg vs Bilastine 80 mg p = 0.01.

Mentions: The statistical comparison of the data is shown in Figure 1. There were not significant differences in efficacy between fexofenadine and bilastine, rupatadine and bilastine, and desloratadine and levocetirizine. However, fexofenadine, rupatadine, and bilastine showed significantly higher efficacy than desloratadine or levocetirizine, and rupatadine had higher efficacy than fexofenadine.Table 2


Comparative efficacy of non-sedating antihistamine updosing in patients with chronic urticaria.

Sánchez-Borges M, Ansotegui I, Jimenez JM, Rojo MI, Serrano C, Yañez A - World Allergy Organ J (2014)

Efficacy of increased doses of nonsedating antihistamines in patients with chronic urticaria. A) According to mean pruritus score (MPS). *Fexofenadine 120 mg vs Fexofenadine 240 mg p = 0.01, ¶ Fexofenadine 120 mg vs Rupatadine 20 mg p = 0.0001, ♦ Fexofenadine 240 mg vs Rupatadine 20 mg p = 0.03. B) According to percentage of symptom-free patients. * Desloratadine 10 mg vs Desloratadine 120 mg, Desloratadine 10 mg vs Levocetirizine 10 mg, Desloratadine 10 mg vs Levocetirizine 20 mg, Desloratadine 20 mg vs Levocetirizine 10 mg, Desloratadine 20 mg vs Levocetirizine 20 mg, Levocetirizine 10 mg vs Levocetirizine 20 mg, Bilastine 40 mg vs Bilastine 80 mg p n.s. ¶ Desloratadine 10 mg vs Bilastine 40 mg p = 0.006. ♦ Desloratadine 10 mg vs Bilastine 80 mg p = 0.002. ♠ Desloratadine 20 mg vs Bilastine 40 mg, Desloratadine 20 mg vs Bilastine 80 mg, Levocetirizine 10 mg vs Bilastine 40 mg p = 0.02. ♣ Levocetirizine 10 mg vs Bilastine 80 mg p = 0.01.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
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getmorefigures.php?uid=PMC4363057&req=5

Fig1: Efficacy of increased doses of nonsedating antihistamines in patients with chronic urticaria. A) According to mean pruritus score (MPS). *Fexofenadine 120 mg vs Fexofenadine 240 mg p = 0.01, ¶ Fexofenadine 120 mg vs Rupatadine 20 mg p = 0.0001, ♦ Fexofenadine 240 mg vs Rupatadine 20 mg p = 0.03. B) According to percentage of symptom-free patients. * Desloratadine 10 mg vs Desloratadine 120 mg, Desloratadine 10 mg vs Levocetirizine 10 mg, Desloratadine 10 mg vs Levocetirizine 20 mg, Desloratadine 20 mg vs Levocetirizine 10 mg, Desloratadine 20 mg vs Levocetirizine 20 mg, Levocetirizine 10 mg vs Levocetirizine 20 mg, Bilastine 40 mg vs Bilastine 80 mg p n.s. ¶ Desloratadine 10 mg vs Bilastine 40 mg p = 0.006. ♦ Desloratadine 10 mg vs Bilastine 80 mg p = 0.002. ♠ Desloratadine 20 mg vs Bilastine 40 mg, Desloratadine 20 mg vs Bilastine 80 mg, Levocetirizine 10 mg vs Bilastine 40 mg p = 0.02. ♣ Levocetirizine 10 mg vs Bilastine 80 mg p = 0.01.
Mentions: The statistical comparison of the data is shown in Figure 1. There were not significant differences in efficacy between fexofenadine and bilastine, rupatadine and bilastine, and desloratadine and levocetirizine. However, fexofenadine, rupatadine, and bilastine showed significantly higher efficacy than desloratadine or levocetirizine, and rupatadine had higher efficacy than fexofenadine.Table 2

View Article: PubMed Central - PubMed

Affiliation: Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad and Clínica El Avila, 6a transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060 Venezuela.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Urticaria and angioedema lasting more than 6 weeks have been designated as chronic urticaria (CU)... It encompasses two major subtypes: chronic spontaneous urticaria (CSU) (previously known as chronic idiopathic urticaria) (CIU) and chronic inducible urticaria... In patients that do not respond to standard doses, the next step in guideline-based therapy is to increase AH doses up to 4 times... Investigations assessing the response to various NSAHs have demonstrated that up-dosing is significantly more effective in reducing symptoms of CU than standard-dose treatment... A literature search of PubMed/MEDLINE looking specifically at the studies that investigated the effects of increased doses of NSAHs in patients with all subtypes of CU was conducted... A number of publications that evaluated different NSAHs in increasing doses have clearly demonstrated that a higher proportion of patients previously uncontrolled exhibit significant improvements of their symptoms after going through this approach... It is important to mention that these enhanced results have generally been accomplished without compromising patient’s safety, since no increased rates of side effects, including somnolence, have been observed... The mechanisms explaining patient’s benefits from up-dosing are not completely understood, but increased in vivo receptor occupancy, and effects of antihistamines on additional receptors have been proposed... In a previous review article we had proposed that favorable responses to high doses of NSAHs in patients with CU were not uniformly observed, and it was likely that there would be dissimilar results when outcomes from different studies were compared... Somnolence, drowsiness, or sedation was uncommon, although for patients treated with rupatadine 20 mg somnolence was observed more often than in the placebo group in two studies... The utilization of increased doses of desloratadine, levocetirizine, and bilastine has not been associated with adverse effects... The results presented in this paper must be taken into consideration cautiously because there is a large heterogeneity between studies included in regard to various aspects of the investigation such as the subtype of chronic urticaria under study, duration of the treatment, study design, drug doses, and primary outcomes... We can conclude that increased doses of NSAHs show an improved efficacy in patients with CU who do not respond to approved doses.

No MeSH data available.


Related in: MedlinePlus