Comparative effectiveness and safety of drug therapy for chronic urticaria: a network meta-analysis and risk-benefit assessment

ABSTRACTBackground Chronic urticaria (CU) is a prevalent chronic skin condition characterized by recurrent wheals. Clinical guidelines recommend multiple drugs for CU treatment. Our study aims to compare the effectiveness and safety of drug therapy for CU.Methods We conducted a comprehensive search of randomized controlled trials (RCTs) and real-world studies (RWSs) in PubMed, EMBASE, and Cochrane. A network meta-analysis (NMA) was conducted to assess the response rate, decline in Urticaria Activity Score over 7 Days (UAS7), Dermatology Life Quality Index (DLQI), and adverse event rates of standard-dose and high-dose H1 antihistamine (H1AH), omalizumab (OMA) 75, 150, and 300 mg, cyclosporine and placebo. The risk-benefit assessment was conducted by probabilistic simulation and stochastic multicriteria acceptability analysis (SMAA).Results A total of 39 studies were identified, including 37 RCTs and 2 RWSs. OMA 300 mg and 150 mg both had significantly higher response rate than standard-dose H1AH (p < 0.05, respectively). OMA 300 mg and 150 mg both consistently led to a huge drop in UAS7 and DLQI compared to standard-dose H1AH and high-dose H1AH (p < 0.05).Conclusion Regarding risk-benefit assessment, OMA 300 mg emerges as the optimal pharmacological intervention for CU, while OMA 150 mg stands as a secondary alternative compared to H1 antihistamines and cyclosporine.KEYWORDS: Chronic urticarianetwork meta-analysisrisk-benefit assessmentdrug therapytreatment effectivenessH1 antihistamineomalizumabcyclosporine AcknowledgmentsAll the authors were responsible for the concept and design of the study as well as interpretation of the data, writing of the article, reviewing, and final reviewing of this article.Declaration of interestsThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresOne reviewer has received fees from Novartis as a speaker. Another reviewer reports grants and honoraria as a speaker from Novartis, Taiho, and honoraria as a speaker from Sanofi, Kyowa Kirin, Korin, Mitsubishi-Tanabe, Torii, and Kaken Pharmaceutical. The reviewers have no other relevant financial relationships or otherwise to disclose.Author contribution statementConception and design: F Hao. Acquisition of data: All authors. Analysis and interpretation of data: T Qian and X Jiang. Drafting of the manuscript: T Qian. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: T Qian. Obtaining funding: F Hao. Administrative, technical, or material support: All authors. Supervision: F Hao.Additional informationFundingThis paper was funded by Natural Science Foundation of Chongqing, China(cstc2021ycjh-bgzxm0291).