{"title":"肉毒杆菌毒素皮下注射治疗带状疱疹后神经痛的疗效和安全性与镇痛药的比较：随机对照试验的系统回顾和荟萃分析。","authors":"Hui Wang, Ping Lin","doi":"10.3389/fneur.2024.1479931","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this meta-analysis is to investigate the efficacy and safety of a subcutaneous injection of botulinum toxin in the treatment of postherpetic neuralgia (PHN) compared to analgesics.</p><p><strong>Methods: </strong>We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and Wanfang for randomized controlled trials (RCTs) from inception to 10 September 2023. The primary clinical outcomes included visual analog scale (VAS) pain scores and clinical effective rates. The secondary clinical outcome included the adverse event rate during follow-up.</p><p><strong>Results: </strong>A total of 14 studies with 1,358 participants were included in the meta-analysis. Among the included patients, 670 participants received botulinum toxin A injections and 688 participants received other medication treatments. The botulinum toxin-A (BTX-A) group exhibited lower pain scores [week 2: Mean difference (MD): -1.91, 95% confidence interval (CI): -2.63 to -1.20, and <i>p</i> < 0.00001; week 4: MD: -1.69, 95% CI: -2.69 to -0.68, and <i>p</i> < 0.00001; week 8: MD: -1.66, 95% CI: -2.20 to -1.12, and <i>p</i> < 0.00001; week 12:MD: -1.83, 95% CI: -2.70 to -0.96, and <i>p</i> < 0.00001; and week 24: MD: -1.07, 95% CI: -1.16 to -0.99, and <i>p</i> < 0.00001]. The effective rate was significantly higher in patients who received BTX-A for postherpetic neuralgia compared to those who received lidocaine or gabapentin (lidocaine: MD: -1.55, 95% CI: -2.84 to -0.27, and <i>p</i> = 0.02 and gabapentin: MD: -1.57, 95% CI: -2.12 to -1.02; and <i>p</i> < 0.00001). There was no difference in the incidence of adverse events between the treatment groups [odds ratio (OR): 1.25, 95% CI: 0.43 to 3.61, and <i>p</i> = 0.69].</p><p><strong>Conclusion: </strong>Our meta-analysis showed that BTX-A has certain advantages in relieving postherpetic neuralgia compared to analgesics. In addition, BTX-A is safe for treating postherpetic neuralgia, with no notable side effects.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/, identifier CRD42021289813.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"15 ","pages":"1479931"},"PeriodicalIF":2.7000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524963/pdf/","citationCount":"0","resultStr":"{\"title\":\"Efficacy and safety of subcutaneous injection of botulinum toxin in the treatment of Chinese postherpetic neuralgia compared to analgesics: a systematic review of randomized controlled trials and meta-analysis.\",\"authors\":\"Hui Wang, Ping Lin\",\"doi\":\"10.3389/fneur.2024.1479931\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The purpose of this meta-analysis is to investigate the efficacy and safety of a subcutaneous injection of botulinum toxin in the treatment of postherpetic neuralgia (PHN) compared to analgesics.</p><p><strong>Methods: </strong>We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and Wanfang for randomized controlled trials (RCTs) from inception to 10 September 2023. The primary clinical outcomes included visual analog scale (VAS) pain scores and clinical effective rates. The secondary clinical outcome included the adverse event rate during follow-up.</p><p><strong>Results: </strong>A total of 14 studies with 1,358 participants were included in the meta-analysis. Among the included patients, 670 participants received botulinum toxin A injections and 688 participants received other medication treatments. The botulinum toxin-A (BTX-A) group exhibited lower pain scores [week 2: Mean difference (MD): -1.91, 95% confidence interval (CI): -2.63 to -1.20, and <i>p</i> < 0.00001; week 4: MD: -1.69, 95% CI: -2.69 to -0.68, and <i>p</i> < 0.00001; week 8: MD: -1.66, 95% CI: -2.20 to -1.12, and <i>p</i> < 0.00001; week 12:MD: -1.83, 95% CI: -2.70 to -0.96, and <i>p</i> < 0.00001; and week 24: MD: -1.07, 95% CI: -1.16 to -0.99, and <i>p</i> < 0.00001]. The effective rate was significantly higher in patients who received BTX-A for postherpetic neuralgia compared to those who received lidocaine or gabapentin (lidocaine: MD: -1.55, 95% CI: -2.84 to -0.27, and <i>p</i> = 0.02 and gabapentin: MD: -1.57, 95% CI: -2.12 to -1.02; and <i>p</i> < 0.00001). There was no difference in the incidence of adverse events between the treatment groups [odds ratio (OR): 1.25, 95% CI: 0.43 to 3.61, and <i>p</i> = 0.69].</p><p><strong>Conclusion: </strong>Our meta-analysis showed that BTX-A has certain advantages in relieving postherpetic neuralgia compared to analgesics. In addition, BTX-A is safe for treating postherpetic neuralgia, with no notable side effects.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/, identifier CRD42021289813.</p>\",\"PeriodicalId\":12575,\"journal\":{\"name\":\"Frontiers in Neurology\",\"volume\":\"15 \",\"pages\":\"1479931\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-10-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524963/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Neurology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fneur.2024.1479931\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fneur.2024.1479931","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：本荟萃分析旨在研究皮下注射肉毒素治疗带状疱疹后遗神经痛（PHN）与镇痛药相比的有效性和安全性：我们检索了PubMed、Cochrane图书馆、Embase、Web of Science、中国国家知识基础设施（CNKI）和万方数据库中从开始到2023年9月10日的随机对照试验（RCT）。主要临床结果包括视觉模拟量表（VAS）疼痛评分和临床有效率。次要临床结果包括随访期间的不良事件发生率：共有 14 项研究、1,358 名参与者被纳入荟萃分析。在纳入的患者中，670 人接受了 A 型肉毒毒素注射，688 人接受了其他药物治疗。肉毒杆菌毒素A（BTX-A）组的疼痛评分较低[第2周]：平均差（MD）：-1.91，95% 置信区间（CI）：-2.63 至-1.20，p p p p p = 0.02；加巴喷丁：MD: -1.57, 95% CI: -2.12 to -1.02; and p p = 0.69]：我们的荟萃分析表明，与镇痛药相比，BTX-A 在缓解带状疱疹后遗神经痛方面具有一定优势。此外，BTX-A治疗带状疱疹后遗神经痛是安全的，没有明显的副作用。系统综述注册：https://www.crd.york.ac.uk/prospero/，标识符为CRD42021289813。
Efficacy and safety of subcutaneous injection of botulinum toxin in the treatment of Chinese postherpetic neuralgia compared to analgesics: a systematic review of randomized controlled trials and meta-analysis.
Objective: The purpose of this meta-analysis is to investigate the efficacy and safety of a subcutaneous injection of botulinum toxin in the treatment of postherpetic neuralgia (PHN) compared to analgesics.
Methods: We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and Wanfang for randomized controlled trials (RCTs) from inception to 10 September 2023. The primary clinical outcomes included visual analog scale (VAS) pain scores and clinical effective rates. The secondary clinical outcome included the adverse event rate during follow-up.
Results: A total of 14 studies with 1,358 participants were included in the meta-analysis. Among the included patients, 670 participants received botulinum toxin A injections and 688 participants received other medication treatments. The botulinum toxin-A (BTX-A) group exhibited lower pain scores [week 2: Mean difference (MD): -1.91, 95% confidence interval (CI): -2.63 to -1.20, and p < 0.00001; week 4: MD: -1.69, 95% CI: -2.69 to -0.68, and p < 0.00001; week 8: MD: -1.66, 95% CI: -2.20 to -1.12, and p < 0.00001; week 12:MD: -1.83, 95% CI: -2.70 to -0.96, and p < 0.00001; and week 24: MD: -1.07, 95% CI: -1.16 to -0.99, and p < 0.00001]. The effective rate was significantly higher in patients who received BTX-A for postherpetic neuralgia compared to those who received lidocaine or gabapentin (lidocaine: MD: -1.55, 95% CI: -2.84 to -0.27, and p = 0.02 and gabapentin: MD: -1.57, 95% CI: -2.12 to -1.02; and p < 0.00001). There was no difference in the incidence of adverse events between the treatment groups [odds ratio (OR): 1.25, 95% CI: 0.43 to 3.61, and p = 0.69].
Conclusion: Our meta-analysis showed that BTX-A has certain advantages in relieving postherpetic neuralgia compared to analgesics. In addition, BTX-A is safe for treating postherpetic neuralgia, with no notable side effects.
期刊介绍：
The section Stroke aims to quickly and accurately publish important experimental, translational and clinical studies, and reviews that contribute to the knowledge of stroke, its causes, manifestations, diagnosis, and management.
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