Mi-Ae Kim, Jeong-Hee Choi, Yoo-Seob Shin, Hae-Sim Park, Young-Min Ye
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The clinical outcomes included urticaria control status, symptoms, and rescue medication use.</p><p><strong>Results: </strong>This study included 109 patients. After 4 weeks of second-line treatment, urticaria was well-controlled, partly controlled, and uncontrolled in 43.1%, 36.7%, and 20.2% of patients, respectively. Complete control of CU was achieved in 20.4% of patients. Among the patients with high-dose nsAHs, the proportion with well-controlled status was higher compared to the patients who received standard doses (51.9% vs. 34.5%, <i>P</i> = 0.031). No significant difference was observed in the proportion of well-controlled cases between the updosing and combination treatment groups (57.7% vs. 46.4%, <i>P</i> = 0.616). However, increasing the dose of nsAHs 4-fold was associated with a higher rate of complete symptom control compared to multiple combination treatment with 4 nsAHs (40.0% vs. 10.7%, <i>P</i> = 0.030). Logistic regression analysis confirmed the higher efficacy of updosing of nsAHs for complete control of CU compared to the other treatment strategies (odds ratio, 0.180; <i>P</i> = 0.020).</p><p><strong>Conclusions: </strong>In patients with CU refractory to standard doses of nsAHs, both updosing of nsAHs 4-fold and multiple combination treatment with 4 nsAHs increased the rate of well-controlled cases without causing significant adverse effects. 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Few studies have evaluated the efficacy of second-line treatments of CU, particularly for patients being considered for costly third-line treatments such as omalizumab. We compared the efficacy and safety of second-line treatments of CU refractory to standard doses of nonsedating H<sub>1</sub>-antihistamines (nsAHs).</p><p><strong>Methods: </strong>This 4-week, prospective, randomized, open-label trial divided patients into 4 treatment groups: 4-fold updosing of nsAHs, multiple combination of 4 nsAHs, switching to other nsAHs, and adjunctive H<sub>2</sub>-receptor antagonist. The clinical outcomes included urticaria control status, symptoms, and rescue medication use.</p><p><strong>Results: </strong>This study included 109 patients. After 4 weeks of second-line treatment, urticaria was well-controlled, partly controlled, and uncontrolled in 43.1%, 36.7%, and 20.2% of patients, respectively. Complete control of CU was achieved in 20.4% of patients. 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引用次数: 1
摘要
目的:慢性荨麻疹(CU)的患病率在全球范围内呈上升趋势,给患者带来了沉重的负担。很少有研究评估CU二线治疗的疗效,特别是考虑接受昂贵的三线治疗(如omalizumab)的患者。我们比较了难治CU的二线治疗与标准剂量非镇静h1 -抗组胺药(nsAHs)的疗效和安全性。方法:这项为期4周的前瞻性、随机、开放标签试验将患者分为4个治疗组:4倍增加nsAHs, 4种nsAHs的多重联合,切换到其他nsAHs,以及辅助h2受体拮抗剂。临床结果包括荨麻疹控制状况、症状和抢救用药情况。结果:本研究纳入109例患者。经过4周的二线治疗,分别有43.1%、36.7%和20.2%的患者荨麻疹得到良好控制、部分控制和未控制。20.4%的患者CU得到完全控制。在高剂量nsAHs患者中,控制良好的比例高于接受标准剂量的患者(51.9% vs. 34.5%, P = 0.031)。两组对照良好的病例比例差异无统计学意义(57.7% vs 46.4%, P = 0.616)。然而,与4种nsAHs的多重联合治疗相比,将nsAHs剂量增加4倍与更高的完全症状控制率相关(40.0%比10.7%,P = 0.030)。Logistic回归分析证实,与其他治疗策略相比,增加nsAHs剂量完全控制CU的疗效更高(优势比,0.180;P = 0.020)。结论:在标准剂量非甾体类药物难治性CU患者中,非甾体类药物4倍加药和4种非甾体类药物多次联合治疗均可增加控制良好病例的发生率,且无明显不良反应。与联合治疗相比,增加nsAHs对完全控制CU更有效。
Efficacy of Second-Line Treatments in Chronic Urticaria Refractory to Standard Dose Antihistamines.
Purpose: The prevalence of chronic urticaria (CU) is increasing worldwide, and it imposes a major burden on patients. Few studies have evaluated the efficacy of second-line treatments of CU, particularly for patients being considered for costly third-line treatments such as omalizumab. We compared the efficacy and safety of second-line treatments of CU refractory to standard doses of nonsedating H1-antihistamines (nsAHs).
Methods: This 4-week, prospective, randomized, open-label trial divided patients into 4 treatment groups: 4-fold updosing of nsAHs, multiple combination of 4 nsAHs, switching to other nsAHs, and adjunctive H2-receptor antagonist. The clinical outcomes included urticaria control status, symptoms, and rescue medication use.
Results: This study included 109 patients. After 4 weeks of second-line treatment, urticaria was well-controlled, partly controlled, and uncontrolled in 43.1%, 36.7%, and 20.2% of patients, respectively. Complete control of CU was achieved in 20.4% of patients. Among the patients with high-dose nsAHs, the proportion with well-controlled status was higher compared to the patients who received standard doses (51.9% vs. 34.5%, P = 0.031). No significant difference was observed in the proportion of well-controlled cases between the updosing and combination treatment groups (57.7% vs. 46.4%, P = 0.616). However, increasing the dose of nsAHs 4-fold was associated with a higher rate of complete symptom control compared to multiple combination treatment with 4 nsAHs (40.0% vs. 10.7%, P = 0.030). Logistic regression analysis confirmed the higher efficacy of updosing of nsAHs for complete control of CU compared to the other treatment strategies (odds ratio, 0.180; P = 0.020).
Conclusions: In patients with CU refractory to standard doses of nsAHs, both updosing of nsAHs 4-fold and multiple combination treatment with 4 nsAHs increased the rate of well-controlled cases without causing significant adverse effects. Updosing of nsAHs is more effective for complete CU control than combination treatment.
期刊介绍:
The journal features cutting-edge original research, brief communications, and state-of-the-art reviews in the specialties of allergy, asthma, and immunology, including clinical and experimental studies and instructive case reports. Contemporary reviews summarize information on topics for researchers and physicians in the fields of allergy and immunology. As of January 2017, AAIR do not accept case reports. However, if it is a clinically important case, authors can submit it in the form of letter to the Editor. Editorials and letters to the Editor explore controversial issues and encourage further discussion among physicians dealing with allergy, immunology, pediatric respirology, and related medical fields. AAIR also features topics in practice and management and recent advances in equipment and techniques for clinicians concerned with clinical manifestations of allergies and pediatric respiratory diseases.