Effects of bepotastine, a nonsedating H1-antihistamine, for the treatment of persistent cough and allergic rhinitis: a randomised, double-blind, placebo-controlled trial

Abstract

BackgroundEmpirical therapy with oral histamine-1 receptor antagonists (H1RAs) is often used for patients with suspected upper airway cough syndrome. No placebo-controlled trials with non-sedating H1RAs (nsH1RAs) have evaluated validated cough outcomes.ObjectiveTo assess the effect of an nsH1RA, bepotastine, on cough outcomes in patients with allergic rhinitis (AR) and persistent cough.MethodsA randomized, double-blind, placebo-controlled trial was conducted. Adult patients with persistent cough (>3 weeks in duration) and symptomatic AR were recruited and randomly assigned to receive either bepotastine or placebo at a 1:1 ratio. The primary outcome was cough-specific quality of life assessed by the Leicester Cough Questionnaire (LCQ). Secondary outcomes included cough severity visual analog scale (VAS), throat VAS, Cough Hypersensitivity Questionnaire, Sinonasal Outcome Test-22 score, and drug adverse events.ResultsBetween October 2021 and September 2022, 50 participants (43 females; mean age: 46.28 years; median cough duration: 3 months) were assigned to either the bepotastine 10 mg twice daily or placebo group in a 1:1 ratio. After two weeks of treatment, both bepotastine and placebo groups showed significant improvements in the LCQ scores, but there was no significant difference in the magnitude of change between the groups (3.45±2.10versus3.04±2.94, p=0.576). Secondary outcomes were also comparable.ConclusionsDespite the relatively small sample size, our study clearly demonstrated that a two-week treatment with bepotastine did not provide therapeutic benefits for cough outcomes. These findings suggest against the use of nsH1RAs with the intention of improving cough outcomes even in patients with persistent cough and AR.