For patients with chronic spontaneous urticaria (CSU), dapsone appears to be a safe and effective second-line therapy if H1-antihistamines and other first-line treatment options have failed, according to the results of a retrospective medical record review.

In order to assess the safety and efficacy of dapsone, a sulfone antibiotic, in the treatment of CSU, the study authors reviewed the medical records of 79 CSU patients treated with dapsone. Patients included in the study had presented to the New York University School of Medicine between January 1, 2005 to April 15, 2017. Efficacy was assessed based on patient improvement, complete response, and remission.

Of the total 79 patients included in the study, 45 had chronic idiopathic urticaria while 34 had chronic autoimmune urticaria. “Improvement in CSU was observed in 62 patients (78%) (36 [80%] with idiopathic and 26 [76%] with autoimmune disease) with dapsone,” the authors stated. The average (SD) time to improvement was reported as 1.1 (1.0) months. 

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“A complete response was achieved in 29 (47%) of these 62 patients (16 [44%] with idiopathic and 13 [50%] with autoimmune disease),” the study authors added. The average (SD) time to complete response was reported as 5.2 (5.2) months. Following a sustained complete response, dapsone was tapered after an average (SD) of 2.4 (2.2) months in 21 patients and was discontinued in 18 patients. “Ten patients experienced remission with no subsequent flares, even after dapsone therapy was discontinued with follow-up of 0.3 to 10.0 months,” the authors added.

Results of the study also found dapsone to be generally well-tolerated. The study authors reported that 16 patients experienced mild adverse effects while 2 patients experienced serious adverse effects (methemoglobinemia, drug reaction with eosinophilia and systemic symptoms).

According to the results of this retrospective review, dapsone is both a safe and effective second-line therapy for the management of CSU.

Reference

Liang, SE, et al. Use of Dapsone in the Treatment of Chronic Idiopathic and Autoimmune Urticaria. JAMA Dermatology. DOI: 10.1001/jamadermatol.2018.3715