Dutch guideline on chronic urticaria - Treatment with cyclosporin

The Dutch guideline Chronic Urticaria aims to introduce a stepped-care model for the treatment of chronic spontaneous urticaria (CSU). In this manuscript ciclosporin is discussed as potential treatment option. Ciclosporin is a systemic calcineurin inhibitor with immunosuppressive properties. We have used the GRADE approach to assess several outcome measures with regards to ciclosporin, including disease activity, quality of life, adverse events, and complete and partial response. We have included and evaluated four studies among which two randomised controlled trials and two observational studies. The risk of bias varied from unclear to high risk and the overall quality of the evidence was considered to be low. Treatment with ciclosporin resulted in improvement of disease activity based on moderate quality of the evidence. Furthermore, ciclosporin improved quality of life (low quality evidence). There is low quality of evidence that the percentage of patients suffering from adverse events after treatment with ciclosporin was not statistically different from patients treated with placebo.