Comparative efficacy and safety of biologics and systemic immunomodulatory treatments for chronic urticaria: Systematic review and network meta-analysis
Among individuals with chronic urticaria refractory to antihistamines, standard-dose omalizumab and remibrutinib are among the most effective drugs across multiple patient-important outcomes with a favorable safety profile across the studied duration. Cyclosporine may be effective but may be among the most harmful. Dupilumab improves itch and wheals, but it is uncertain whether it improves angioedema or quality of life. Lower doses of omalizumab are of intermediate effectiveness and favorable safety. The net benefit of conventional immunosuppressants is uncertain.
Authors
- Joseph J. Moellman
- Donna D. Gardner (ORCID: https://orcid.org/0000-0001-5541-7397)
- Lehana Thabane (ORCID: https://orcid.org/0000-0003-0355-9734)
- Janice Hua Xu
- Xiajing Chu (ORCID: https://orcid.org/0000-0002-6283-8074)
- Kathryn E. Wheeler
- Tonya Winders (ORCID: https://orcid.org/0000-0001-7689-6438)
- Andrew Dam
- Kathryn P Trayes
- David A. Khan (ORCID: https://orcid.org/0000-0001-9880-6181)
- Winfred Frazier (ORCID: https://orcid.org/0000-0003-3373-0918)
- Emily Cole
- Sameer K. Mathur (ORCID: https://orcid.org/0000-0001-7656-0256)
- Daniel Rayner (ORCID: https://orcid.org/0000-0001-6699-3090)
- Sarbjit S. Saini (ORCID: https://orcid.org/0000-0001-8522-2742)
- Jeffrey Shi Kai Chan (ORCID: https://orcid.org/0000-0003-0231-2393)
- E Oliver (ORCID: https://orcid.org/0000-0003-4840-2140)
- Paul Oykhman
- Moshe Ben‐Shoshan (ORCID: https://orcid.org/0000-0001-9083-1518)
- Derek K. Chu (ORCID: https://orcid.org/0000-0001-8269-4496)
- Rachel N. Asiniwasis
- Lisa A. Beck (ORCID: https://orcid.org/0000-0002-8452-667X)
- Jonathan A. Bernstein (ORCID: https://orcid.org/0000-0002-3476-1196)
- A. Chu (ORCID: https://orcid.org/0000-0003-0201-2630)
- Diane R. Baker
- Sanaz Eftekhari (ORCID: https://orcid.org/0000-0002-4419-4973)
- Susan Waserman
- Javed Sheikh (ORCID: https://orcid.org/0000-0002-5108-6663)
- Lauren Runyon
- David M. Lang
- Maisie Flindall
- Jamie Tattrie
- Sukhdeep Bhangal
Institutions
- Western University (CA)
- Cleveland Clinic (US)
- University of Wisconsin–Madison (US)
- Johns Hopkins University (US)
- Oregon Health & Science University (US)
- University of Pittsburgh (US)
- University of Toronto (CA)
- University of Regina (CA)
- Washington University in St. Louis (US)
- Queen's University (CA)
- Thomas Jefferson University Hospital (US)
- Johns Hopkins Medicine (US)
- Asthma and Allergy Foundation of America (US)
- McGill University Health Centre (CA)
- Southlake Regional Health Center (CA)
- University of Rochester Medical Center (US)
- University of Florida (US)
- Ontario Clinical Oncology Group (CA)
- Los Angeles Medical Center (US)
- Asthma Association (BG)
- Impact (CA)
- McGill University (CA)
- St. Joseph’s Healthcare Hamilton (CA)
- University of Cincinnati (US)
- The University of Texas Southwestern Medical Center (US)
- University of Cincinnati Medical Center (US)
- McMaster University (CA)
Publication Details
- Journal
- Journal of Allergy and Clinical Immunology
- Published
- 2025-07-16
- DOI
- https://doi.org/10.1016/j.jaci.2025.06.004
- Citations
- 15
- Primary Topic
- Urticaria and Related Conditions
- Type
- article
- Field-Weighted Citation Impact
- 25.02