Impact of Pharmacological Treatments for Chronic Spontaneous Urticaria with an Inadequate Response to H1-Antihistamines on Health-Related Quality of Life: A Systematic Review and Network Meta-Analysis

Abstract

Background: Recently, pharmacological treatment options for H1-antihistamine–refractory chronic spontaneous urticaria have increased dramatically; however, their effects on patient-reported outcomes, including health-related quality of life (HRQOL), remain unclear. Objective: To compare the impact of these treatments on HRQOL among H1-antihistamine–refractory patients with chronic spontaneous urticaria. Methods: We completed a comprehensive search of the available literature in the electronic databases, gray literature, and preprint reports up to April 19, 2021, with no language restrictions. The primary outcome for evaluation was a change in HRQOL from the baseline, and secondary outcomes included patient unacceptability and other patient-reported outcomes. We used a random-effects network meta-analysis and estimated differences in standardized mean differences (SMDs) and odds ratios with 95% CIs. Evidence-based synthesis was based on magnitudes of effect size, evidence certainty, ranking of treatment effects, and clinically meaningful improvement. Results: Twelve randomized controlled trials encompassing 1866 adolescent and adult patients were included. Our evidence synthesis analyses revealed that hydroxychloroquine (SMD, −1.00 [−1.61 to −0.39]), 72 mg ligelizumab (SMD, −0.66 [−0.96 to −0.35]), 240 mg ligelizumab (SMD, −0.67 [−0.98 to −0.37]), and 300 mg omalizumab (SMD, −0.53 [−0.67 to −0.39]) significantly improved HRQOL with a moderate beneficial effect. However, the use of hydroxychloroquine seems to be limited by a higher risk of patient unacceptability of treatment. Other secondary outcomes remain inconclusive based on the available evidence. Conclusions: Both ligelizumab (72 or 240 mg) and 300 mg omalizumab appeared to be effective treatments for H1-antihistamine–refractory chronic spontaneous urticaria, because they were closely associated with improved HRQOL.