No benefit of adjuvant leukotriene receptor antagonists with antihistamines in chronic urticaria: Study

The study findings suggest that leukotriene receptor antagonists with antihistamines do not have better outcomes than antihistamines alone regarding total symptom score (TSS) and pruritus in patients with chronic urticaria.

Chronic urticaria, characterized by persistent and recurrent hives lasting more than six weeks, significantly burdens patients' quality of life. While antihistamines serve as the primary treatment, many patients continue to experience symptoms despite adherence to standard therapies. This has spurred interest in exploring alternative or adjunctive treatments for achieving better symptom control and improved outcomes.

Certain guidelines recommend a second-generation H1-antihistamine (AH) as a first-line treatment for CU patients. However, some patients show insufficient response to a standard dose of this therapy and might benefit from leukotriene receptor antagonist addition. Led by Ocílio Ribeiro Gonçalves, Federal University of Piauí (UFPI), Teresina, Brazil, the systematic review and meta-analysis aimed to compare LTA plus antihistamines with antihistamines alone.

For this purpose, the researchers searched online databases for randomized clinical trial (RCT) data comparing LTA plus AH treatment to AH alone in patients with CU.

The meta-analysis included three studies comprising 234 patients with urticaria. The patients' mean age was 37.23 years in the leukotriene antagonist + antihistamines (LTA + AH) group and 39.14 years in the antihistamines (AH) group. Follow-up ranged from 2 to 18 months between studies.

The study led to the following findings:

• There was no statistically significant difference between groups in terms of TSS level (SMD: −74.82), nor in terms of pruritus (MD: −0.07).
• After sensitivity analysis, with the systematic exclusion of each study from the grouped estimates, the result for TSS level did not change.

In conclusion, the researchers scrutinized the efficacy of combining leukotriene receptor antagonists with second-generation H1-antihistamines (AH) versus AH alone in treating chronic urticaria. They found no significant difference in TSS levels or pruritus between the groups. The results were confirmed by further analysis, suggesting that LTA addition to AH does not yield superior results in CU.

As research in chronic urticaria continues to evolve, the insights gleaned from this meta-analysis pave the way for future investigations into novel therapeutic avenues and optimization of patient care. With a growing understanding of the complex immune mechanisms driving chronic urticaria, the prospect of improved treatment strategies offers hope for better outcomes and enhanced quality of life for affected individuals.

Reference:

Gonçalves, O. R., A. Ribeiro, V. E., L. Galvão, M. T., Silva, S., S. Sobral, M. V., A. Kojima, G. S., R. Freitas, J. L., & Soares, V. G. Leukotriene receptor antagonists as adjuvant therapy of antihistamines in chronic urticaria: A systematic review and meta-analysis. International Journal of Dermatology. https://doi.org/10.1111/ijd.17172