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Quality of evidence. Sixteen studies with 2659 randomized patients qualified for the network meta-analysis on the change in the UAS7. Fig. 2 shows the structure of the network with 17 treatments and how these were compared with each other in the original studies. Placebo was used by most studies as comparator [21,22,23,24, 27, 29, 30, 32,33,34,35, 37, 40, 41, 47], several studies compared different dosages of the same agent [21, 24, 32, 33, 35, 40, 41, 44, 47], and only a three studies directly compared different systemic medications [21, 32, 39]. Fig. 3 shows the efficacy of the different medications in reducing the UAS7 in relation to placebo and the ranking of treatments according to the P -score. Omalizumab injected every 4 weeks in a dosage of 300 mg was ranked the most effective currently available drug for the reduction of the UAS7 with a score reduction of −10.45 (95% CI: −12.35, −8.55) compared to placebo. Cyclosporine in an oral dosage of 3–5 mg/kg daily was ranked the second most effective currently available drug with a score reduction of −10.40 (95% CI: −19.40, −1.40) compared to placebo. Ligelizumab 72 mg injected every 4 weeks (−11.67, 95% CI: −16.80, −7.15; GRADE: moderate certainty) and daily oral administration of fenebrutinib 400 mg (−9.50, 95% CI: −17.56, −1.44; GRADE: moderate certainty) showed promising efficacies in reducing the UAS7 compared to placebo; however, published data showed no significant differences in efficacy compared to omalizumab 300 mg injected every 4 weeks or cyclosporine 3 to 5 mg/kg daily per os. Estimated mean differences for the change in UAS7 for all possible treatment comparisons are listed in Online Appendix D Table D1. Copa vip cashback 1xbet Asia Sub 23. Cyclosporine appears to be effective for antihistamine-refractory CSU but the data suggests a less favorable safety profile compared to other treatment options including omalizumab. The certainty of evidence is moderate due to imprecision, which is the result of a low sample size for cyclosporine.
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