Clinical Dermatology Review (Jan 2022)
Comparative clinical assessment of updosing of bilastine and combination of levocetirizine and hydroxyzine in chronic spontaneous urticaria
Abstract
Background: Second-generation antihistamines (SGAHs) are first-line drugs in management of chronic spontaneous urticaria (CSU). However, almost 50% of the patients do not respond to standard dose of SGAH. Various guidelines recommend either updosing of SGAH or combination of different antihistamines in such patients. However, the studies comparing these treatment regimens are limited. Materials and Methods: In this comparative study, CSU patients were randomized to receive standard dose of either bilastine or levocetirizine for 2 weeks. After 2 weeks of treatment, nonresponders received a double dose of bilastine while hydroxyzine 25 mg once daily was added in the levocetirizine group. Patients were primarily evaluated for improvement in CSU, quality of life (QOL), and somnolence. Results: At the end of 2 weeks, 23/39 and 17/36 achieved well-controlled urticaria, and at the end of 4 weeks, 9/16 and 5/19 patients achieved well-controlled urticaria in the bilastine and levocetirizine groups, respectively. Only one patient in the bilastine group was symptom free and none in levocetirizine at the end of 4 weeks. At week 2, there was no statistical difference in Urticaria Activity Score over 7 days (UAS7) improvement between both the groups, however, at week 4, there was a statistical difference (P < 0.05). Somnolence was significantly lower in the bilastine group (P < 0.05). Bilastine was statistically significant (P < 0.05) in the improvement of QOL by CU-Q2oL as compared to levocetirizine. No major adverse events were reported during study period, however, bilastine was associated with significantly lower Adverse events (AEs) compared to levocetirizine (P < 0.05). Conclusion: Updosing of bilastine improves CSU symptoms without compromising safety as compared to combination of levocetirizine and hydroxyzine.
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