(%)Serum responseASST was not predictive of response to CsA treatment (= 0.34).(+)(?)(+)(?)55/58 (94.8)3/58 (5.2)N/AN/AN/AN/ABlood basophilOpen-label prospective studyEndo et al. clinical improvement after CsA treatment. Conclusions Since most positive results were from non-RCT articles and some data were still inconsistent, this systematic review identified no reliable practical biomarker for predicting CsA treatment response in patients with CSU. There were no 1-Methyladenine positive predictors with good consistency and mechanical plausibility. studies showed that pre-incubating leukocytes with CsA inhibited histamine release after stimulation with sera from CSU patients.3 CsA has been shown to reduce histamine, leukotriene, and 1-Methyladenine prostaglandin release by mast cells and basophils both and studies, review articles, case reports, case series, comments, and replies were excluded. Non-English articles and non-full-text publications were excluded. The remaining articles were initially screened by 2 independent reviewers (K.K. and C.S.), who subsequently obtained full texts and reviewed 1-Methyladenine them for eligibility. Thirteen relevant articles were systematically reviewed (Figure). Open in a separate window Figure Flow diagram of literature review in this study. Thirteen studies met the inclusion criteria and were included in our systematic review.CsA, cyclosporine A; CSU, chronic spontaneous urticaria; RCT, randomized controlled trial; ASST, autologous serum skin test; BHRA, basophil histamine release assay; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; ANA, antinuclear antibody; TA, thyroid autoantibody; Ig, immunoglobulin; CIC, circulating immune complex; IL, interleukin; TNF-, tumor necrosis factor alpha. *For analysis of relationship between clinical factorsincluding prior histories of urticaria, disease severity and disease duration4 studies were included13,16,22,23; ?For the correlation between histamine-releasing activity and CsA response in CSU, 8 studies were included6,14,15,16,18,19,21,23, involving the ASST,6,15,16,18,19,21,23 and BHRA6,14,16; ?Three studies showed a correlation between coagulation and inflammatory factors and the CsA response, involving D-dimer,13 CRP,13,17,22 and ESR13; Autoantibodies, including ANA,16,22 TAs,13,16,22 and other autoantibodies22,23 were shown in 4 studies; llFour studies showed a correlation between cytokines and the CsA response, involving immunophenotypical lymphocytes (CD3, CD4, CD56, CD57, CD19, CD19+CD5+, and CD19+CD23+)20; Igs, C3, C4, and CICs20; serum IgE22, 23; IL-2; IL-5; and TNF-.7 Data extraction and bias assessments The data extraction was independently conducted by 2 reviewers. The following characteristics were identified in each study: i) the first author’s name and the publication year; ii) study design; iii) number of CsA-treated patients and controls; iv) number of studied patients; v) CsA dose and treatment duration; vi) severity and treatment-response assessment; and vii) predicting factors for a CsA response. Discrepancies were resolved by consensus discussion between the authors. In the case of RCTs, the quality and risk of bias 1-Methyladenine were assessed using Cochrane Collaboration’s tool for assessing the risk of bias,10 and for non-RCTs, the Methodological Index for Non-Randomized Studies (Supplementary Table S1).11 The studies identified as being relevant to a CsA response in CSU were assessed for their evidence levels using the Grading of Recommendations Assessment, Development and Evaluation system.12 RESULTS Literature search results A total of 13 studies (404 patients with CSU and 200 healthy patients) met the eligibility criteria and were Rabbit Monoclonal to KSHV ORF8 included in our systematic review (Figure).6,7,13,14,15,16,17,18,19,20,21,22,23 There were 1 RCT6; 8 open-labelled, prospective studies7,13,15,17,18,20,21,23; and 3 retrospective studies.14,16,22 One study was an RCT at first, but was subsequently switched to an open-labelled, prospective study because of control failures.19 The quality and risk of bias of the 1-Methyladenine studies included were shown in Supplementary Table S1. Potential factors for response to CsA treatment We classified factors into 5 categories: clinical factors, histamine-releasing factors, coagulation and inflammatory factors, autoantibodies, and cytokines. Because 1 study might report more than 1 outcome, so each study might be shown in more than.