Chronic spontaneous urticaria (CSU), a debilitating condition, adversely affects the patient′s quality of life. Recently, bilastine, a nonsedative H1-antihistamine, has been introduced for its treatment. The present study compared the effectiveness, safety and tolerability of bilastine 20 mg vs. levocetirizine 5 mg in moderate to severe CSU. It included patients (18-65 years) with moderate to severe CSU and randomized them to receive either bilastine 20 mg (n = 31) or levocetirizine 5 mg (n = 27) once daily for 42 days.

The study used UAS7, VAS and DLQI to assess the severity of urticaria, global urticaria-induced discomfort and quality of life, respectively. It assessed DLQI at baseline (D0) and end-of-treatment (D42), while assessing UAS7 and VAS at baseline and all follow-up visits. The study looked for UAS7 alteration and changes in DLQI and VAS. It evaluated safety by recording drug-related adverse events, biochemical investigations, electrocardiograms and tolerability and compliance. 

The study observed:

• Improvement in UAS7, DLQI and VAS at end-of-treatment (D42) with both the drugs.
• Bilastine improved all parameters at the end-of-treatment, but only UAS7 reduction was significant (bilastine > levocetirizine).
• UAS7 and VAS improved significantly from D14 onwards. It was maintained throughout the study in both groups.
• Bilastine showed significantly less sedation.
• Neither drug showed any serious adverse effects.
• Tolerability was similar for both drugs. 

This study proves bilastine to be a more effective and less-sedative novel therapy for CSU than levocetirizine, with a similar effect on the quality of life.

Source: Podder I, Das A, Ghosh S, et al. Effectiveness, safety, and tolerability of bilastine 20 mg vs levocetirizine 5 mg for the treatment of chronic spontaneous urticaria: a double-blind, parallel-group, randomized controlled trial. Dermatol Ther. 2020;33(6):e13946.