Comparative Safety Profiles of Individual Second-Generation H1-Antihistamines for the Treatment of Chronic Urticaria: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Wasuchon Chaichan; Chidchanok Ruengorn; Kednapa Thavorn; Brian Hutton; Jacek C Szepietowski; Jonathan A Bernstein; Mati Chuamanochan; Surapon Nochaiwong

doi:10.1016/j.jaip.2023.03.058

Comparative Safety Profiles of Individual Second-Generation H1-Antihistamines for the Treatment of Chronic Urticaria: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

J Allergy Clin Immunol Pract. 2023 Aug;11(8):2365-2381. doi: 10.1016/j.jaip.2023.03.058. Epub 2023 Apr 23.

Authors

Wasuchon Chaichan¹, Chidchanok Ruengorn², Kednapa Thavorn³, Brian Hutton⁴, Jacek C Szepietowski⁵, Jonathan A Bernstein⁶, Mati Chuamanochan⁷, Surapon Nochaiwong⁸

Affiliations

¹ Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
² Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
³ Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada; Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada; Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.
⁶ Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
⁷ Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand. Electronic address: mati.c@cmu.ac.th.
⁸ Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand. Electronic address: surapon.nochaiwong@gmail.com.

PMID: 37088368
DOI: 10.1016/j.jaip.2023.03.058

Abstract

Background: The comparative safety and/or dosing regimens of individual second-generation H1-antihistamines (sgAHs) in patients with chronic urticaria (CU) remain poorly elucidated.

Objective: To compare the safety profiles of individual sgAHs and/or dosing regimens in adolescents or adult patients with CU using a systematic review and network meta-analysis of all available evidence.

Methods: With limited English publications, electronic databases and gray literature were searched for randomized clinical trials from inception, with searches last updated on January 20, 2023. Relevant safety outcomes included treatment unacceptability (all-cause discontinuation), tolerability (discontinuation due to any adverse events), adverse events, serious adverse events, central nervous system (CNS) side effects, and anticholinergic side effects. Regarding the network estimates, the probability of being associated with the highest adverse outcome risk was estimated for each treatment comparison.

Results: Fifty-one randomized clinical trials with 14 individual sgAHs and different dosing regimens, involving 7502 participants, were included. On the basis of the findings from network meta-analyses, variations in sgAH treatment comparisons were observed regarding the unacceptability of treatment, tolerability, adverse events, and CNS side effects. There were no statistically significant differences between the results of sgAH treatment for serious adverse events and those for anticholinergic side effects. On the basis of the ranking of safety profiles, emedastine 4 mg, mizolastine 10 mg, and cetirizine 10 mg were the top 3 ranked treatments with unfavorable safety profiles associated with CNS side effects and any adverse events.

Conclusions: These findings suggest evidence of variations in safety profiles among sgAHs for CU treatment, particularly in terms of adverse events and CNS side effects.

Keywords: Adverse events; Chronic urticaria; Network meta-analysis; Safety profiles; Second-generation H1-antihistamines.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Cholinergic Antagonists
Chronic Urticaria* / drug therapy
Drug-Related Side Effects and Adverse Reactions*
Histamine H1 Antagonists, Non-Sedating*
Humans
Network Meta-Analysis
Randomized Controlled Trials as Topic

Substances

Histamine H1 Antagonists, Non-Sedating
Cholinergic Antagonists