Olopatadine vs. Rupatadine for Allergic Rhinitis: A Meta-Analysis of Randomized Controlled Trials

This systematic review and meta-analysis aimed to compare the efficacy and safety of olopatadine and rupatadine in the treatment of allergic rhinitis (AR). By synthesizing data from randomized controlled trials (RCTs), this study aimed to evaluate symptom reduction, specifically in terms of the Total Nasal Symptom Score (TNSS), and assess the incidence of adverse effects between these two second-generation antihistamines. A comprehensive literature search was conducted in PubMed, Google Scholar, Web of Science, Embase, and Cochrane databases from November 2024 to February 2025. Studies were selected based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical trials comparing olopatadine and rupatadine in AR patients were included, with a focus on TNSS reduction and adverse event incidence. The Jadad scale was used for quality assessment. Data were analyzed using the DerSimonian and Laird random effects model, with mean differences and risk ratios (RR) calculated. Heterogeneity was assessed using the chi-square test and I² statistic. A total of four RCTs involving 304 patients (153 in the olopatadine group, 151 in the rupatadine group) met the inclusion criteria. Olopatadine demonstrated superior TNSS reduction (mean difference: 2.51; 95% CI: 1.58 to 3.44; p<0.0001), with low heterogeneity (I²=0%). Adverse events were comparable between groups (RR=0.66; 95% CI: 0.29-1.50; P=0.33), with dry mouth, headache, and mild sedation being the most frequently reported. Olopatadine showed greater efficacy in reducing symptoms of allergic rhinitis compared to rupatadine, while both drugs had similar safety profiles. These findings suggest that olopatadine may be preferred for more symptom relief, though larger trials are needed for further validation.