Study Compares Benefits, Harms of Treatments for Chronic Hives
WEDNESDAY, July 23, 2025 -- Omalizumab and remibrutinib may be the most effective treatments for reducing hives, itch, and swelling with chronic urticaria, according to a study published online July 15 in the Journal of Allergy and Clinical Immunology.
Alexandro W.L. Chu, M.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues systematically synthesized the comparative benefits and harms of systemic treatments for chronic urticaria.
The researchers identified 93 studies (including 11,398 mostly adult and adolescent participants across 83 randomized trials and 10 nonrandomized studies) that evaluated 42 interventions. Standard-dose omalizumab (300 mg every four weeks) and remibrutinib were found to be among the most effective for improving multiple patient-important outcomes with high certainty, although the safety profile of remibrutinib is less certain. While dupilumab improved urticaria activity, the researchers found its impact on quality of life is uncertain and no dupilumab trials addressed angioedema activity. Cyclosporine appeared to be among the most effective treatments for improving urticaria activity but was among the most harmful for frequency of any adverse events. Data indicated outcomes may be improved with azathioprine, dapsone, hydroxychloroquine, mycophenolate, sulfasalazine, and vitamin D. Benralizumab, quilizumab, and tezepelumab may not be more effective than placebo, though the evidence was uncertain. Findings were similar across age groups and baseline severity, and they persisted in subgroup analyses.
"This first comprehensive analysis of all advanced treatment options for chronic urticaria provides a clear and evidence-based ‘menu of treatment options’ for patients and their clinicians to choose from," senior author Derek Chu, M.D., Ph.D., also from McMaster University, said in a statement.
Several authors disclosed ties to the pharmaceutical industry.
Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.
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