The effectiveness of bilastine and fexofenadine updosing in the management of chronic spontaneous urticaria

In patients not responding to standard dosages of second-generation antihistamines (SGAHs), updosing up to 4-fold is recommended. Even though SGAHs are safe, the concerns regarding their safety after updosing still remain and the studies directly comparing the updosing of different SGAHs are lacking thus making the choice of drug difficult. Eighty patients with chronic spontaneous urticaria (CSU) were randomized to receive either bilastine or fexofenadine (40 in each group). Patients were started on conventional dose of either drug (bilastine 20 mg or fexofenadine 180 mg) for the first 2 weeks. Those patients who remained symptomatic after 2 weeks (UAS ≥ 7) were given double dose of bilastine (20 mg BD) or fexofenadine (180 mg BD), respectively, for another 2 weeks. Control of urticaria was assessed by evaluating UAS score. Patients’ quality of life was assessed by CU-Q2oL questionnaire. Safety was evaluated by analyzing the adverse events (AEs) reported by the patients. Seventy-four patients completed the study. Forty-one patients (bilastine – 23 and fexofenadine – 18) achieved adequate control of urticaria (UAS ≤ 6) at week 2. Out of 33 patients who were given high dose of bilastine or fexofenadine, 17 patients (bilastine – 9 and fexofenadine – 8) achieved adequate control of urticaria at week 4. Bilastine was associated with significant improvement in quality of life of patients compared to fexofenadine (32.38 ± 5.83 vs. 38.71 ± 5.92.; P < 0.005). Thirteen patients (six in bilastine group and seven in fexofenadine group) reported one or more AEs with sedation being the most common side effect. Updosing of bilastine provided relief from urticaria symptoms, improved quality of life in the majority of the patients without compromising somnolence or safety. Bilastine was associated with improved quality of life and less sedation compared to fexofenadine.