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Efficacy and Safety of Bilastine in the Treatment of Allergic Rhinitis: A Systematic Review and Meta-analysis.

ABSTRACT: Bilastine is a non-sedating second generation H1 oral antihistamine (OAH) for treating allergic rhinitis (AR) patients. The effect of bilastine has not previously been evaluated in a meta-analysis. The aim of this review was to determine the efficacy and safety of bilastine in treating AR. An electronic literature search was performed using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Science Direct and Google Scholar up to March 2021. Randomized controlled trials comparing bilastine with placebo and standard pharmacotherapy were included. The included studies must have diagnosis of AR established by clinicians and the outcomes must have a minimum of 2 weeks of follow-up period. The primary outcomes assessed were total symptom score (TSS), nasal symptom score (NSS) and non-nasal symptom score (NNSS). The secondary outcomes were discomfort due to rhinitis, quality of life (QOL) and adverse events. The risk of bias and quality of evidence for all studies were appraised. The meta-analysis was done using Review Manager 5.3 software based on the random-effects model. The search identified 135 records after removal of duplicates. Following screening and review of the records, fifteen full-text articles were assessed for eligibility. Five trials involving 3,329 patients met the inclusion criteria. Bilastine was superior to placebo in improving TSS, NSS, NNSS, rhinitis discomfort score and QOL but has comparable efficacy with other OAHs in TSS, NSS, NNS, rhinitis discomfort score and QOL. There was no difference in adverse effects when bilastine was compared against placebo and other OAHs except for somnolence. Bilastine has fewer incidence of somnolence compared to cetirizine. The overall quality of evidence ranged from moderate to high quality. Bilastine is effective and safe in treating the overall symptoms of AR with comparable efficacy and safety with other OAHs except somnolence. Whilst bilastine has similar efficacy to cetirizine, somnolence is notably less in bilastine.

SUBMITTER: Singh Randhawa A

PROVIDER: S-EPMC8784885 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Herbal medicine is popularly used among patients who suffer from allergic rhinitis. This systematic review and meta-analysis was conducted to evaluate the efficacy and safety of single medicinal plants in the management of allergic rhinitis. We searched MEDLINE, CENTRAL, and Web of Science for randomised controlled trials which evaluated the use of single medicinal plant for allergic rhinitis among adults and children. Twenty-nine randomised controlled trials (n = 1879) were eligible while 27 (n = 1769) contributed data for meta-analyses. Most studies (studies = 20) compared medicinal plants against placebo and Petasites hybridus was most frequently investigated (studies = 5). Very-low-to-low-certainty evidence suggests that compared to placebo, single medicinal plants may improve overall total nasal symptoms (SMD -0.31, 95% CI -0.59 to -0.02; participants = 249; studies = 5; I2 = 21%) especially nasal congestion and sneezing; and rhinoconjunctivitis quality of life (RQLQ) scores (MD -0.46, 95% CI -0.84 to -0.07; participants = 148; studies = 3; I2 = 0%). Moderate-certainty evidence show no clear differences between single medicinal plants and antihistamine in overall symptoms (Total nasal symptoms: SMD -0.14, 95% CI -0.46 to 0.18; participants = 149; studies = 2; I2 = 0%). As adjunctive therapy, moderate-certainty evidence shows that medicinal plants improved SNOT-22 scores when given as intranasal treatment (MD -7.47, 95% CI -10.75 to -4.18; participants = 124; studies = 2; I2 = 21%). Risk of bias domains were low or not clearly reported in most studies while heterogeneity was substantial in most pooled outcomes. Route of administration and age were identified to be plausible source of heterogeneity for certain outcomes. Medicinal plants appear to be well tolerated up to 8 weeks of use. Clear beneficial evidence of medicinal plants for allergic rhinitis is still lacking. There is a need for improved reporting of herbal trials to allow for critical assessment of the effects of each individual medicinal plant preparation in well-designed future clinical studies.

Project description:IntroductionAllergic rhinitis (AR) is a common allergic disorder that impairs social and physical functioning as well as quality of life. It is characterized by sneezing, rhinorrhea, congestion, and itching which respond suboptimally to drug therapy. Low-level laser therapy (LLLT) has anti-inflammatory and immunosuppressive properties that have shown promise in some studies. We aimed to systematically review LLLT's effectiveness in treating AR and meta-analyze our findings.MethodsA systematic search of PubMed, Scopus, and Web of Science was conducted on November 24, 2023. All studies investigating LLLT on AR were included, and a pre-post meta-analysis of nasal symptoms (rhinorrhea, nasal congestion, nasal itching, and sneezing) in the LLLT-treated arm was conducted. Rhinoconjunctivitis quality of life questionnaire (RQLQ) scores before and after LLLT were also meta-analyzed alongside a pairwise meta-analysis of LLLT with placebo, acupuncture, steroids/antihistamines, and ultraviolet lasers. A random-effects model was used with a conservative pre-post correlation of 0.4 and standardized mean difference (SMD) as the effect size.ResultsSixteen studies were included in this review, and we found that nasal symptoms are alleviated post-LLLT in people with AR (SMD: -1.4, 95 CI: [-2.07 to -1.13], p value <0.001). RQLQ scores were also reduced after LLLT (SMD = -0.72, 95 CI: [-0.94 to -0.50], p value <0.001), and very few adverse events were reported. This meta-analysis, however, had significant publication bias and heterogeneity. When compared to a placebo, LLLT did not significantly improve nasal symptoms (SMD: -0.69, p value = 0.167), which might mean the post-LLLT nasal symptom alleviation is due to a placebo effect. Comparisons to other treatment modalities were too few to deduce anything meaningful, although it does appear that LLLT is less effective than UV lasers.ConclusionLLLT is most likely effective at alleviating nasal symptomology and has a low likelihood of adverse event incidence, yet more high-quality studies with larger sample sizes are needed to compare LLLT to a placebo to ensure its superiority to the placebo effect, as well as non-inferiority clinical trials to compare it to standard treatments.

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Efficacy and Safety of Bilastine in the Treatment of Allergic Rhinitis: A Systematic Review and Meta-analysis.

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