Meta-Analysis of the Efficacy of Ebastine 20 mg Compared to Loratadine 10 mg and Placebo in the Symptomatic Treatment of Seasonal Allergic Rhinitis

Abstract

Background: Few randomized studies have compared the efficacy of ebastine and loratadine in the symptomatic treatment of seasonal allergic rhinitis (SAR). Methods: A meta-analysis was performed on data from four randomized, double-blind, placebo-controlled, parallel-group clinical trials comparing the efficacy of ebastine 20 mg once daily versus loratadine 10 mg once daily in the symptomatic treatment of SAR symptoms. Primary efficacy variable was the mean change in the overall mean daily reflective total symptom score (TSS), i.e. the sum of five rhinitis symptom scores: nasal discharge, nasal congestion, nasal itching, sneezing and total eye symptoms (itchy/watery eyes) over the first 2 weeks of treatment compared to baseline. Results: There were 2,089 patients in the population analyzed: 749, 739 and 601 patients in the ebastine 20 mg, loratadine 10 mg and placebo groups, respectively. Compared to baseline, overall mean daily reflective TSS over the first 2 weeks of treatment was –3.61 (35.4% reduction from baseline) in the ebastine group, –3.05 (29.0% reduction) in the loratadine group and –2.30 (22.7% reduction) in the placebo group. Statistically significant differences in the mean change from baseline were found when comparing ebastine and loratadine (p < 0.001), ebastine and placebo (p < 0.0001), and loratadine and placebo (p < 0.0001). The global effect (i.e. the difference in overall mean daily reflective TSS over the first 2 weeks of treatment) of ebastine compared with loratadine over the first 2 weeks of treatment was –0.56 (95% confidence interval, CI, –0.86 to –0.26), and it was sustained during the whole (4-week) period studied. The global effects of ebastine and loratadine compared with placebo were –1.30 (95% CI, –1.61 to –0.99) and –0.74 (95% CI, –1.05 to –0.43), respectively. Secondary variables (reflective and snapshot individual symptom scores) showed the same trend. Conclusions: This meta-analysis confirms that ebastine 20 mg has a good efficacy profile, inducing a greater decrease from baseline in mean rhinitis symptom scores than loratadine 10 mg or placebo.

The diagnosis and management of rhinitis: An updated practice parameter

“…326,327 A recent meta-analysis found ebastine (an agent not available in the United States) superior to loratadine for the decrease in mean rhinitis symptom scores in seasonal allergic rhinitis. 915 Several studies have found cetirizine to be superior to loratadine, although in 1 study, the differences were not statistically significant. 915 In a study of patients with seasonal allergic rhinitis who remained symptomatic after treatment with fexofenadine, azelastine significantly improved total nasal symptom score.…”

“…915 Several studies have found cetirizine to be superior to loratadine, although in 1 study, the differences were not statistically significant. 915 In a study of patients with seasonal allergic rhinitis who remained symptomatic after treatment with fexofenadine, azelastine significantly improved total nasal symptom score. 335 The availability of second-generation antihistamines has substantially improved the therapeutic utility of antihistamines, because patients such as older adults who otherwise would avoid antihistamine therapy as a result of sedation or anticholinergic effects can be given antihistamine medications that are favorable for allergic rhinitis management from a risk/benefit standpoint.…”

Subcutaneous immunotherapy and pharmacotherapy in seasonal allergic rhinitis: A comparison based on meta-analyses

“…We expanded this comparison by selecting studies of other molecules and treatments, including fexofenadine, 49 loratadine, 50 ebastine, 50 ciclesonide, 51 and fluticasone propionate nasal spray. 52 In this descriptive analysis we also reported one of the trials (the largest for population size) included in the metaanalyses of SCIT, 24 mometasone, 10 desloratadine, 35 and montelukast.…”

The Effectiveness of Modern Antihistamines for Treatment of Allergic Rhinitis - An IPD Meta-Analysis of 140,853 Patients

“…These findings were summarized and discussed by creating systematic reviews and meta-analysis for all antihistamines analysed here. [20][21][22][23][24] In the meta-analysis by Ratner, et al 23 ebastine was compared to loratadine, also an antihistamine from the second generation for the systemic use of allergic diseases. Here ebastine could show a greater decrease in mean rhinitis score from baseline over two and four weeks compared to loratadine and placebo.…”