Víctor Mayoral, Rafael Galvez, Marta Ferrándiz, Xoán Miguéns Vázquez, Carlos Cordero-García, Antonio Alcántara Montero, Concepción Pérez, María Pérez-Páramo
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引用次数: 0
摘要
神经性疼痛是一种普遍且繁重的疾病，普瑞巴林和加巴喷丁被广泛用于治疗神经性疼痛。然而，它们的相对疗效和安全性尚不明确。本荟萃分析旨在评价和比较普瑞巴林与加巴喷丁治疗神经性疼痛的有效性和安全性。方法：本研究遵循PRISMA指南，采用PICOS搜索策略。比较研究（临床试验和队列研究）纳入了用普瑞巴林或加巴喷丁治疗神经性疼痛患者的研究。评估的主要结局是疗效和安全性。数据提取自PubMed、Embase、Scopus和Cochrane Collaboration Library数据库。使用Cochrane Review Manager工具评估偏倚风险。采用Review Manager 5.4.1软件进行统计分析，计算效应量，并根据用药剂量进行敏感性分析。结果：共分析了14项研究，3346例患者。在长达12-14周的不同时间间隔内，普瑞巴林在视觉模拟量表（VAS）中表现出优于加巴喷丁的结果（SMD -0.47, 95% CI -0.74至-0.19）。普瑞巴林组在SF-12/SF-36/EQ-5D评分方面也有显著改善（SMD 0.39, 95% CI 0.11-0.68），无/轻度疼痛天数更长（SMD 9.00, 95% CI 8.93-9.07），重度疼痛天数更短（SMD -3.00, 95% CI -4.96 -1.04）。普瑞巴林导致阿片类药物消耗降低（OR 0.50, 95% CI 0.33-0.76）。加巴喷丁的恶心和呕吐发生率较高。敏感性分析支持普瑞巴林的疗效。结论：普瑞巴林对神经性疼痛的缓解效果优于加巴喷丁。此外，它改善了患者报告的结果，减少了阿片类药物的消耗，并减少了不良事件。系统评价注册：https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=565208, PROSPERO （CRD42024565208）。
Pregabalin vs. gabapentin in the treatment of neuropathic pain: a comprehensive systematic review and meta-analysis of effectiveness and safety.
Introduction: Neuropathic pain is a prevalent and burdensome condition, and both pregabalin and gabapentin are widely used for its treatment. However, there is a lack of clarity regarding their comparative efficacy and safety. This meta-analysis aims to evaluate and compare the effectiveness and safety of pregabalin vs. gabapentin in managing neuropathic pain.
Methods: This study followed PRISMA guidelines and employed the PICOS search strategy. Comparative studies (clinical trials and cohort studies) were included, with patients with neuropathic pain treated either with pregabalin or gabapentin. Primary outcomes assessed were efficacy and safety. Data were extracted from PubMed, Embase, Scopus, and the Cochrane Collaboration Library databases. The risk of bias was evaluated using the Cochrane Review Manager tool. Statistical analysis was performed using Review Manager 5.4.1 software, calculating effect sizes and conducting sensitivity analysis based on medication dosage.
Results: A total of 14 studies with 3,346 patients were analyzed. Pregabalin showed superior results compared to gabapentin in the Visual Analog Scale (VAS) at various time intervals up to 12-14 weeks (SMD -0.47, 95% CI -0.74 to -0.19). The pregabalin group also had significant improvements in SF-12/SF-36/EQ-5D scores (SMD 0.39, 95% CI 0.11-0.68) and experienced more days with no/mild pain (MD 9.00, 95% CI 8.93-9.07) and fewer days with severe pain (MD -3.00, 95% CI -4.96 to -1.04). Pregabalin resulted in lower opioid consumption (OR 0.50, 95% CI 0.33-0.76). Gabapentin had a higher incidence of nausea and vomiting. Sensitivity analysis supported the efficacy of pregabalin.
Conclusion: In conclusion, pregabalin demonstrated superior and faster efficacy in alleviating neuropathic pain than gabapentin did. Additionally, it improved patient-reported outcomes, resulted in lower opioid consumption, and led to fewer adverse events.
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