The daily maintenance therapy with Rupatadine led to a substantial improvement in both  chronic spontaneous urticaria (CSU) disease activity and the quality of life (QoL) when compared to on-demand (OD) treatment, a recent randomized trial issued in the “European Journal of Allergy and Immunology” described. Nevertheless, it's important to note that these improvements were not sustained after discontinuing Rupatadine.

Karsten Weller and a team of distinguished researchers compared OD and daily maintenance regimens using the non-sedating antihistamine - Rupatadine, exploring the effectiveness of Rupatadine up-dosing and the potential for long-term disease-modifying effects.

Patients underwent a 2-week screening phase, followed by 8 weeks of double-blind treatment, and a 6-week treatment-free follow-up period, during which OD therapy was permitted.

Adult patients were randomly assigned to receive either 10 mg of Rupatadine when needed (OD) or 10 mg of Rupatadine daily. At the 4-week mark, if patients didn't achieve a complete response, they increased the dose to 20 Rupatadine at 20 mg daily or undertook sham up dosing if they were on the 10 mg Rupatadine OD regimen. The primary focus of this trial was to distinguish between CSU disease activity between the daily and OD treatments at the follow-up.

Additionally, examiners assessed the effectiveness of Rupatadine up dosing, and emphasized on disease activity, QoL, and disease control. As found, at the 4-week point, patients receiving daily Rupatadine experienced noteworthy improvements in disease activity and QoL than those on OD treatment. Notably, the up-dosing of Rupatadine did not have a momentous impact on the mean disease activity, but it did increase the number of total responders from 5% to 22%.

However, as the study concluded, disease activity between patients treated with OD versus daily Rupatadine did not display a statistically notable difference. The findings of the study underscored the advantages of a daily maintenance schedule with a non-sedating H1-antihistamines.