Clinical effectiveness and safety of cetirizine versus rupatadine in chronic spontaneous urticaria: a randomized, double‐blind, 6‐week trial

Abstract

Background Urticaria is a distressing condition associated with diverse clinical presentations. Chronic spontaneous urticaria (CsU) is characterized by wheals and angioedema. Its treatment requires an algorithmic approach to identify the optimum medication. Objectives Cetirizine is commonly used in the treatment of urticaria. Rupatadine is a selective non‐sedating H1‐antihistamine approved for the treatment of CsU. This trial was conducted to ascertain whether the properties of rupatadine offer advantages over cetirizine. Methods Seventy patients with CsU were enrolled. Parameters assessed included: (i) mean number of wheals (MNW); (ii) pruritus; (iii) mean total symptom score (MTSS); (iv) size of wheal; (v) interference of wheals with sleep; and (vi) sedation. Patients with CsU were divided randomly into two groups. Routine investigations were performed at baseline and at the end of the study. Results Evaluations of MTSS, MNW, and pruritus revealed statistically significant differences at week 3 compared with baseline in the cetirizine group. However, greater reductions in these parameters were obtained with rupatadine. In patients receiving rupatadine, reductions in the MNW, size of wheals, and intensity of erythema were also significant at six weeks (P < 0.001) and were significantly greater than those in the cetirizine group (P < 0.05). Conclusions Improvements in MTSS, MNW, size of wheals, intensity of erythema, and differential eosinophil count imply that rupatadine is a particularly attractive therapeutic modality compared with cetirizine for the treatment of CsU.

Presence of positive skin prick tests to inhalant allergens and markers of T2 inflammation in subjects with chronic spontaneous urticaria (CSU): a systematic literature review

“…One study, Anuradha et al stopped systemic corticosteroids for 4 weeks and the mean eosinophil % was 4.2% (n = 60), while the median was 364 10 6 /L [ 23 ]. Another study, Dakhale et al, stopped systemic corticosteroids for 8 weeks and the mean eosinophil % was 6.8% (n = 64) [ 24 ]. The absolute eosinophil count was not provided.…”

“…Where corticosteroids weren’t held, the mean eosinophil percentage, mean absolute eosinophil count and median absolute eosinophil count were not elevated. Studies did find that antihistamines reduced peripheral blood eosinophil counts in CSU subjects which may help explain these findings [ 23 , 24 , 50 ].…”

Rupatadine in Established Treatment Schemes Improves Chronic Spontaneous Urticaria Symptoms and Patients’ Quality of Life: a Prospective, Non-interventional Trial

“…Thus, rupatadine treatment in the established schemes is suitable to reduce the burden of recurrent CSU episodes in those patients. In previous studies, it was shown that rupatadine was even more effective than desloratadine, cetirizine and levocetirizine with regard to both, benefits in clinical outcome and patients’ QoL [ 28 – 30 ].…”

Lipid Mediators of Allergic Disease: Pathways, Treatments, and Emerging Therapeutic Targets

“…In contrast, rupatadine, a dual second-generation H1 antihistamine and PAFR blocker has proven clinically efficacious in urticaria, allergic rhinitis, and rhinoconjunctivitis [17, 27]. Randomized trials comparing rupatadine and levocetirizine demonstrate that rupatadine is better tolerated and more effective for chronic urticaria (Table 1) [41, 42]. Rupatadine currently is not available in the USA.…”