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H1-Antihistamines for Chronic Spontaneous Urticaria: an Abridged Cochrane Systematic Review

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H1-Antihistamines for Chronic Spontaneous Urticaria: an Abridged Cochrane Systematic Review H1-antihistamines for chronic spontaneous urticaria: An abridged Cochrane Systematic Review Sharma, Maulina , Bennett, C. , Carter, Ben and Cohen, Stuart N. Author post-print (accepted) deposited by Coventry University’s Repository Original citation & hyperlink: Sharma, Maulina , Bennett, C. , Carter, Ben and Cohen, Stuart N. (2015) H1-antihistamines for chronic spontaneous urticaria: An abridged Cochrane Systematic Review . Journal of the American Academy of Dermatology, volume 73 (4): 710-716 http://dx.doi.org/10.1016/j.jaad.2015.06.048 DOI 10.1016/j.jaad.2015.06.048 ISSN 0190-9622 ESSN 1097-6787 Publisher: Elsevier NOTICE: this is the author’s version of a work that was accepted for publication in Journal of the American Academy of Dermatology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of the American Academy of Dermatology, [VOL 73, ISSUE 4, (2015)] DOI: 10.1016/j.jaad.2015.06.048 © 2015, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it. FROM THE COCHRANE LIBRARY H1-antihistamines for chronic spontaneous urticaria: An abridged Cochrane Systematic Review Maulina Sharma, MRCP,a Cathy Bennett, PhD,b Ben Carter, PhD,c andStuartN.Cohen,FRCPd Derby, Coventry, Cardiff, and Nottingham, United Kingdom Background: Chronic spontaneous urticaria is characterized by recurrent itchy wheals. First-line management is with H1-antihistamines. Objective: We sought to conduct a Cochrane Review of H1-antihistamines in the treatment of chronic spontaneous urticaria. Methods: A systematic search of major databases for randomized controlled trials was conducted. Results: We included 73 studies with 9759 participants; 34 studies provided outcome data for 23 comparisons. Compared with placebo, cetirizine 10 mg daily in the short and intermediate term (RR 2.72; 95% confidence interval [CI] 1.51-4.91) led to complete suppression of urticaria. Levocetirizine 20 mg daily was effective for short-term use (RR 20.87; 95% CI 1.37-317.60) as was 5 mg for intermediate-term use (RR 52.88; 95% CI 3.31-843.81). Desloratadine 20 mg was effective for the short term (RR 15.97; 95% CI 1.04- 245.04) as was 5 mg in the intermediate term (RR 37.00; 95% CI 2.31-593.70). There was no evidence to suggest difference in adverse event rates between treatments. Limitations: Some methodological limitations were observed. Few studies for each comparison reported outcome data that could be incorporated in meta-analyses. Conclusions: At standard doses, several antihistamines are effective and safe in complete suppression of chronic spontaneous urticaria. Research on long-term treatment using standardized outcome measures and quality of life scores is needed. ( J Am Acad Dermatol http://dx.doi.org/10.1016/j.jaad.2015.06.048.) Key words: chronic spontaneous urticaria; Cochrane; H1-antihistamines; review; treatment. From the Department of Dermatology, Derby Teaching Hospitals medicine. Drs Carter and Cohen have no conflicts of interest National Health Service Foundation Trust, London Road Com- to declare. munity Hospitala; Centre for Technology Enabled Health The full version of the review is available in the Cochrane Library: Research, Faculty of Health and Life Sciences, Coventry Sharma M, Bennett C, Cohen SN, Carter B. H1-antihistamines for Universityb; Institute of Primary Care and Public Health, Cardiff chronic spontaneous urticaria. Cochrane Database of System- Universityc; and Nottingham University Hospitals National atic Reviews 2014, Issue 11. Art. No.: CD006137. DOI: 10.1002/ Health Service Trust, Queen’s Medical Centre.d 14651858.CD006137.pub2. Cochrane Reviews are regularly Supported by Queen’s Medical Centre Nottingham, and National updated as new evidence emerges and in response to Institute for Health Research, the largest single funder of the feedback, and Cochrane Database of Systematic Reviews Cochrane Skin Group. should be consulted for the most recent version of the review. Disclosure: Dr Sharma has represented the Cochrane Skin Group See www.thecochranelibrary.com for information. as a stakeholder for National Institute for Health and Care Disclaimer: The results of a Cochrane review can be interpreted Excellence Scoping Workshop for Chronic Spontaneous Urti- differently, depending on people’s perspectives and caria: Omalizumab 2014. She has been a subinvestigator for circumstances. The conclusions presented are the opinions of clinical trials conducted in the Department of Dermatology, review authors, and are not necessarily shared by the Cochrane George Eliot Hospitals National Health Service Trust, Nunea- Collaboration. ton (2005-2006), in particular, the Chronic Urticaria Treat- Accepted for publication June 22, 2015. ment Evaluation CUTE Study (NCT00264303). She was not Reprint requests: Maulina Sharma, MRCP, Department of involved in writing of the results and received no payments Dermatology, Derby Teaching Hospitals National Health for her involvement with the clinical trials. Professor Bennett Service Foundation Trust, London Road Community Hospital, is the proprietor of Systematic Research Ltd, a company London Road, Derby DE1 2QY, United Kingdom. E-mail: providing research services; she is an employee of that [email protected]. company and received a consultancy fee for the production Published online ddd. of this review, and travel expenses for travel to work-related 0190-9622/$36.00 meetings and conferences. She has also received consultancy Ó 2015 by the American Academy of Dermatology, Inc. fees for other Cochrane reviews and work in evidence-based http://dx.doi.org/10.1016/j.jaad.2015.06.048 1 REV 5.2.0 DTD YMJD10352_proof 30 July 2015 6:31 pm 2 Sharma et al JAM ACAD DERMATOL n 2015 Chronic spontaneous urticaria (CSU), previously Outcomes known as chronic idiopathic urticaria or chronic We extracted data from studies based on 3 primary ordinary urticaria, is characterized by recurrent itchy outcomes agreed on in the protocol of the review. wheals that appear for no identifiable reason. The These were the proportion of participants with condition is termed ‘‘chronic’’ when recurrent crops complete suppression of urticaria, the proportion appear for more than 6 weeks.1 There is a female to with good or excellent response while taking male predominance of 2:12 with a prevalence of H1-antihistamines, and the proportion with 50% between 0.5% and 1%.3 The or greater improvement in lack of predictability and fre- quality of life (QoL) mea- CAPSULE SUMMARY quency of symptoms often sures while taking H1- leads to distress and anxiety. antihistamines. d Chronic spontaneous urticaria is H1-antihistamines are the We extracted data on 3 characterized by recurrent itchy wheals. mainstay of treatment. These secondary outcomes: serious First-line treatment is with H1- are usually classified as adverse events (requiring antihistamines. first- or second-generation withdrawal of treatment), according to their chemical d At standard doses, several antihistamines minor participant-reported structure and properties. are effective and safe compared with adverse events not requiring Second-generation antihis- placebo. Evidence for higher dosing is withdrawal of treatment, and tamines tend to be less scarce. the proportion of partici- 4 sedating. d Further research is needed for longer pants who relapse within duration of treatment using 1 month of stopping H1- METHODS standardized and validated scores. antihistamines. Inclusion criteria Review authors checked We included randomized and entered the outcome data (numeric and nonnumeric) into RevMan data controlled trials that evaluated the effectiveness 5 of H1-antihistamines compared with placebo or analysis software. We used the Cochrane another active treatment. Individuals of any age Collaboration’s tool for assessing risk of bias, and with a clinical diagnosis of CSU, chronic idiopathic rated the Cochrane risk of bias domains for each urticaria, or chronic ordinary urticaria and use of included study as low risk of bias, high risk of bias, and unclear if the risk of bias was uncertain or H1-antihistamines at any dose, including topical 5 interventions, were included. Terfenadine and unknown. We reported data according to a treat- astemizole were not included as they have been ment by allocation principle whenever possible, Cochrane withdrawn from international markets because of and according to section 16.2.2 of the Handbook for Systematic Reviews of Interventions 6 safety issues.
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