Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430000, China; Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China.
Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China.
Int Immunopharmacol. 2023 Oct;123:110577. doi: 10.1016/j.intimp.2023.110577. Epub 2023 Aug 9.
Immunosuppression is an integral part of treating chronic spontaneous urticaria (CSU), but there is no literature to evaluate the efficacy of multiple immunosuppressive agents.
The comparison of the efficacy, safety, and incidence of adverse effects of four immunosuppressive medicines (tripterygium glycosides, methotrexate, cyclosporine A, and azathioprine) in combination with antihistamines in treating CSU provides a clinical reference and evidence-based medicine for treating CSU.
PUBMED, The Cochrane Library, EMBASE, WANFANG, CNKI, CBM, and clinical trial registration platform were searched to collect relevant randomized controlled trials (RCT) and cohort studies of four immunosuppressive medicines combined with antihistamines for treating CSU. The primary outcomes were the efficacy of weekly urticaria activity score 7 (UAS7) and adverse effects.
This study pooled data from seven randomized clinical trials with 410 participants. The standardized mean differences for change in UAS7 were 0.10 (95% confidence interval (CI), 0.01 to 0.68) for cyclosporine A plus antihistamine; 0.03 (95% CI, 0.00 to 0.23) for azathioprine plus antihistamine; 0.52 (95% CI, 0.32 to 0.85) for tripterygium glycosides plus antihistamine; and 1.54 (95% CI, 0.64 to 3.67) for methotrexate plus antihistamine. There were no significant differences in side effects between these medicines in the limited number of trials and clinical samples.
Our results indicate that cyclosporine A combined with antihistamine resulted in greater improvements regarding the UAS7 in CSU patients and that tripterygium glycosides are also effective in treating CSU.
免疫抑制是治疗慢性自发性荨麻疹（CSU）的重要组成部分，但没有文献评估多种免疫抑制剂的疗效。
比较四种免疫抑制剂（雷公藤多苷、甲氨蝶呤、环孢素 A 和硫唑嘌呤）联合抗组胺药治疗 CSU 的疗效、安全性和不良反应发生率，为 CSU 的治疗提供临床参考和循证医学依据。
检索 PUBMED、The Cochrane Library、EMBASE、万方、CNKI、CBM 和临床试验注册平台，收集四种免疫抑制剂联合抗组胺药治疗 CSU 的随机对照试验（RCT）和队列研究。主要结局指标为每周荨麻疹活动评分 7（UAS7）的疗效和不良反应。
本研究共纳入 7 项 RCT，共 410 例患者。环孢素 A 联合抗组胺药组 UAS7 变化的标准化均数差为 0.10（95%置信区间（CI）：0.01 至 0.68）；硫唑嘌呤联合抗组胺药组为 0.03（95%CI：0.00 至 0.23）；雷公藤多苷联合抗组胺药组为 0.52（95%CI：0.32 至 0.85）；甲氨蝶呤联合抗组胺药组为 1.54（95%CI：0.64 至 3.67）。由于试验数量和临床样本有限，这些药物的不良反应之间无显著差异。
我们的结果表明，环孢素 A 联合抗组胺药治疗 CSU 患者的 UAS7 改善更为显著，雷公藤多苷也有效治疗 CSU。
