Omalizumab (600 mg or 300 mg) and ligelizumab (240 mg or 72 mg) can be suggested as effective agents for the management of adolescents or adults with H1 antihistamine-refractory chronic spontaneous urticaria.

This systematic review and network meta-analysis aimed to explore different therapy effects of pharmacologic therapies for people with chronic spontaneous urticaria (CSU) exhibiting an unsatisfactory response to H1 antihistamines.

Databases like Cochrane Library, CINAHL, MEDLINE, Embase, Scopus, PubMed, and Web of Science were searched without any language restrictions. Also, gray literature from Google Scholar, preprint reports, and ongoing trial registers were searched. Randomized clinical trials utilizing validated measurement tools that determined the advantages and disadvantages of pharmacologic therapies in CSU people were screened for inclusion.

Data was extracted by two researchers. With the aid of random-effects model, the network estimates were calculated and stated as standardized mean differences and odds ratios. The major outcomes that reflect the patient's perspective included alterations in urticaria symptoms from the baseline and unacceptability of therapy (all-cause dropouts).

Overall, 23 randomized clinical trials with 2480 people that evaluated 18 distinct interventions or dosages and placebo were incorporated. The standardized mean differences for alteration in the urticaria symptoms for ligelizumab (72 mg and 240 mg) and omalizumab (300 mg and 600 mg) is shown in Table 1:

No considerable differences were noted in treatment unacceptability. Regarding the pros and cons, the network estimates showed that the most efficacious therapies were attained with 300 mg or 600 mg omalizumab (moderate beneficial effect) and 72 mg or 240 mg ligelizumab (large beneficial effect).

For managing chronic spontaneous urticaria that is unsatisfactorily managed with H1 antihistamines, biologic agents such as ligelizumab and omalizumab are effective.