A randomized single blinded study comparing efficacy of bilastine versus cetrizine in autoimmune urticaria

Abstract

Autoimmune urticaria (AIU) is characterized by presence of autoantibodies against either anti-FceR1 or anti-IgE autoantibodies. Cetirizine and bilastine are non-sedating H1 receptor antagonist used as first-line treatment for chronic spontaneous urticaria (CSU). In this study we aim to compare the efficacy and safety of bilastine versus cetirizine in AIU. It is a single blinded study, 36 patients with CSU with positive autologous serum skin test (ASST) were randomly assigned to receive bilastine (20mg to 80 mg per day) or cetirizine (10mg to 40 mg per day) for 12 weeks. The urticaria activity score 7 (UAS 7) was documented at baseline, week 1, week 2, week 4, Week 8 and week 12. The chronic urticaria quality of life questionnaire score (CUQ2oL) was evaluated before and after treatment. Safety was assessed according to adverse events reported by patients during treatment period. Overall, 14 male (38.9%) and 22 female (61.1%) patients aged between 21 to 70 years old (40.92 ± 13.59) were randomly assigned to receive bilastine (n=18) and cetirizine (n=18). Baseline UAS 7 scores improved significantly in both treatment groups; in the bilastine group from 21.56 ± 7.91 to 3.22 ± 3.59 (p<0.01) and in the cetirizine group from 17.83 ± 9.282 to 2.75 ± 4.01(p<0.01). The evaluation of CUQ2oL score revealed significant reduction in both groups; in the bilastine group from 47.64 ± 17.29 to 3.20 ± 6.93 (p<0.01) and in the cetirizine group from 45.52 ± 20.57 to 7.42 ± 7.12. There was no significant difference in the UAS 7 and CUQ2oL score reduction over the 12 weeks between the two groups. Patients in the bilastine group experienced lesser side effects compared to the cetirizine group. Bilastine and cetirizine were equally effective during a 12-week treatment period in patients with AIU.