D2.265 - Standard dosage vs. increased dosage of non-sedating antihistamines in pharmacotherapy of chronic spontaneous urticaria

According to approved approaches to pharmacotherapy of chronic spontaneous urticaria (CSU), the first line of treatment for the disease are non-sedating antihistamines (nsAH), which are prescribed in dosages ranging from standard to 4-fold increased. At the same time, a number of publications from real clinical practice show that increasing the dose of nsAH does not lead to a significant improvement in complete control over disease symptoms, and may also be associated with an increase in the number of side effects of the drugs. The aim of the study was to investigate the efficacy and safety of an increased dose of nsAH compared with the standard dose in pharmacotherapy of CSU.

An analysis of data from 249 patients with CSU over 18 years of age who received only nsAH during the outpatient stage of treatment for the disease was conducted. Among the patients, there were 53 male (21.3%) and 196 female (78.7%). Age of patients: at the time of manifestation of CSU – 41.6±1.07 years, at the time of inclusion in the study – 43.6±0.94 years. Patients were divided into 2 groups. The main group included 60 patients receiving an increased dose of nsAH. The control group included 189 patients receiving a standard dose of nsAH.

Complete control over urticaria symptoms was achieved in 22 patients in the main group (42.3%; 95% CI: 35.3-49.4%) and in 80 patients in the control group (36.7%; 95% CI: 35.3-49.4%), p>0.05. Side effects of nsAH were noted in 6 patients of the main group (10.0%; 95% CI: 2.4-17.6%) and in 8 patients of the control group (4.2%; 95% CI: 1.4-7.1%), p>0.05.

According to our data, complete control over the symptoms of CSU is achieved equally often with pharmacotherapy with increased and standard doses of nsAH. Despite the absence of a statistically significant difference, the frequency of side effects of the increased dosage of nsAH was in 2.4 times higher than of the standard dosage. These data require detailed study in order to optimize the approach to the appointment of nsAH in pharmacotherapy of CSU.