Nochaiwong S, Chuamanochan M, Ruengorn C, et al. - For chronic spontaneous urticaria (CSU) cases with an inadequate response to H ₁ antihistamines, the following biologic agents can be recommended as effective treatments: ligelizumab, 72 or 240 mg, and omalizumab, 300 or 600 mg.

• A network meta-analysis of 23 randomized clinical trials including 2,480 participants was conducted to assess different treatment impacts of pharmacologic treatments in patients with H ₁ antihistamine–refractory CSU.

• The standardized mean differences for change in urticaria symptoms were −1.05 and −1.07 for ligelizumab at doses 72 mg and 240 mg, respectively, and were −0.77 and −0.59 for omalizumab 300 mg and 600 mg, respectively.

• Treatment unacceptability did not differ significantly.

• Regarding benefits and harms, ligelizumab, 72 or 240 mg (large beneficial effect) and omalizumab, 300 or 600 mg (moderate beneficial effect) afforded the most efficacious treatments, as revealed by the network estimates.

• Alternative options with small beneficial impacts, namely, dapsone, hydroxychloroquine, cyclosporine, and zafirlukast, can be employed.