scholarly journals Combination Therapy for Neuropathic Pain. A Systematic Review

2021 ◽  
Author(s):  
Ancor Serrano Afonso ◽  
Thiago Carnaval ◽  
Sebastiá Videla Cés
Keyword(s):  
Systematic Review ◽  
Neuropathic Pain ◽  
Combination Therapy ◽  
Meta Analysis ◽  
Complete Analysis ◽  
Secondary Outcome ◽  
Double Blind ◽  
Adult Participants ◽  
Drop Outs ◽  
Quality Evidence

Pharmacological treatment is poorly effective for neuropathic pain (NP). A progressive decrease in the estimated effect of NP drugs has been reported, giving rise to an increase in multimodal analgesic approach. We performed a systematic review to assess whether there is more and better-quality evidence available since the last review. We evaluated the efficacy, tolerability and safety of double-blind randomized controlled trials involving only adult participants comparing combination therapy (CT: ≥ 2 drugs) to placebo and/or at least one other comparator with NP indication. The primary outcome was the proportion of participants reporting ≥ 50% pain reduction from baseline. Secondary outcome was the proportion of drop-outs due to treatment-emergent-adverse-events. After removing duplicates, 2323 citations were screened. 164 articles were assessed for eligibility, from which 16 were included for qualitative analysis. From the latter, only 5 lasted for at least 12 weeks and only 6 complied with required data for complete analysis, but not for meta-analysis. CT has been adopted for years without robust evidence. Efforts to achieve better quality evidence have not improved over the years. In this regard, guidelines for NP should attempt to make recommendations on CT research, prioritizing which combinations to analyze.

scholarly journals Combination Therapy for Neuropathic Pain: A Review of Recent Evidence

2021 ◽  
Vol 10 (16) ◽  
pp. 3533
Author(s):  
Ancor Serrano Afonso ◽  
Thiago Carnaval ◽  
Sebastià Videla Cés
Keyword(s):  
Neuropathic Pain ◽  
Combination Therapy ◽  
Complete Analysis ◽  
Secondary Outcome ◽  
Adult Participants ◽  
Independent Review ◽  
Double Blinded ◽  
Drop Outs ◽  
Robust Evidence ◽  
Quality Evidence

Pharmacological treatment is not very effective for neuropathic pain (NP). A progressive decrease in the estimated effect of NP drugs has been reported, giving rise to an increase in the use of the multimodal analgesic approach. We performed a new independent review to assess whether more and better-quality evidence has become available since the last systematic review. We evaluated the efficacy, tolerability, and safety of double-blinded randomized controlled trials involving only adult participants and comparing combination therapy (CT: ≥2 drugs) with a placebo and/or at least one other comparator with an NP indication. The primary outcome assessed was the proportion of participants reporting ≥50% pain reductions from baseline. The secondary outcome assessed was the proportion of drop-outs due to treatment-emergent adverse events. After removing duplicates, 2323 citations were screened, with 164 articles assessed for eligibility, from which 16 were included for qualitative analysis. From the latter, only five lasted for at least 12 weeks and only six complied with the required data for complete analysis. CT has been adopted for years without robust evidence. Efforts have been made to achieve better-quality evidence, but the quality has not improved over the years. In this regard, guidelines for NP should attempt to make recommendations about CT research, prioritizing which combinations to analyze.

scholarly journals Combination Therapy for Neuropathic Pain: A Review of Recent Evidence

2021 ◽  
Author(s):  
Ancor Serrano Afonso ◽  
Thiago Carnaval ◽  
Sebastiá Videla Cés
Keyword(s):  
Neuropathic Pain ◽  
Combination Therapy ◽  
Primary Outcome ◽  
Complete Analysis ◽  
Secondary Outcome ◽  
Adult Participants ◽  
Independent Review ◽  
Double Blinded ◽  
Drop Outs ◽  
Robust Evidence

Pharmacological treatment is not very effective for neuropathic pain (NP). A progressive decrease in the estimated effect of NP drugs has been reported, giving rise to an increase in the use of the multimodal analgesic approach. We performed a new, independent review to assess whether more evidence and of better-quality has become available since the last systematic review. We evaluated the efficacy, tolerability, and safety of double-blinded, randomized, controlled trials involving only adult participants and comparing combination therapy (CT: ≥ 2 drugs) to a placebo and/or at least one other comparator with an NP indication. The primary outcome assessed was the proportion of participants reporting ≥50% pain reductions from baseline. The secondary outcome assessed was the proportion of drop-outs due to treatment-emergent adverse events. After removing duplicates, 2323 citations were screened, with 164 articles assessed for eligibility, from which 16 were included for qualitative analysis. From the latter, only five lasted for at least 12 weeks and only six complied with the required data for complete analysis. CT has been adopted for years without robust evidence. Efforts have been made to achieve better-quality evidence, but the quality has not improved over the years. In this regard, guidelines for NP should attempt to make recommendations about CT research, prioritizing which combinations to analyze.

scholarly journals Benefits and harms of pregabalin in the management of neuropathic pain: a rapid review and meta-analysis of randomised clinical trials

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023600 ◽  
Author(s):  
Igho J Onakpoya ◽  
Elizabeth T Thomas ◽  
Joseph J Lee ◽  
Ben Goldacre ◽  
Carl J Heneghan
Keyword(s):  
Neuropathic Pain ◽  
Adverse Events ◽  
Meta Analysis ◽  
Peripheral Oedema ◽  
Phase Iii ◽  
Rapid Review ◽  
Secondary Outcome ◽  
Cord Injury ◽  
Quality Evidence

ObjectiveTo assess the benefits and harms of pregabalin in the management of neuropathic pain.DesignRapid review and meta-analysis of phase III, randomised, placebo-controlled trials.ParticipantsAdults aged 18 years and above with neuropathic pain defined according to the International Association for the Study of Pain criteria.InterventionsPregabalin or placebo.Primary and secondary outcome measuresOur primary outcomes were pain (as measured using validated scales) and adverse events. Our secondary outcomes were sleep disturbance, quality of life, Patient Global Impression of Change, Clinician Global Impression scale, anxiety and depression scores, overall discontinuations and discontinuations because of adverse events.ResultsWe included 28 trials comprising 6087 participants. The neuropathic pain conditions studied were diabetic peripheral neuropathy, postherpetic neuralgia, herpes zoster, sciatica (radicular pain), poststroke pain and spinal cord injury-related pain. Patients who took pregabalin reported significant reductions in pain (numerical rating scale (NRS)) compared with placebo (standardised mean difference (SMD) −0.49 (95% CI −0.66 to −0.32, p<0.00001), very low quality evidence). Pregabalin significantly reduced sleep interference scores (NRS) compared with placebo (SMD −0.38 (95% CI −0.50 to −0.26, p<0.00001), moderate quality evidence. Pregabalin significantly increased the risk of adverse events compared with placebo (RR 1.33 (95% CI 1.23 to 1.44, p<0.00001, low quality evidence)). The risks of experiencing weight gain, somnolence, dizziness, peripheral oedema, fatigue, visual disturbances, ataxia, non-peripheral oedema, vertigo and euphoria were significantly increased with pregabalin. Pregabalin was significantly more likely than placebo to lead to discontinuation of the drug because of adverse events (RR 1.91 (95% CI 1.54 to 2.37, p<0.00001), low quality evidence).ConclusionPregabalin has beneficial effects on some symptoms of neuropathic pain. However, its use significantly increases the risk of a number of adverse events and discontinuation due to adverse events. The quality of the evidence from journal publications is low.

scholarly journals Acute sore throat and Fusobacterium necrophorum in primary healthcare: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e042816
Author(s):  
Stefan Malmberg ◽  
Susanna Petrén ◽  
Ronny Gunnarsson ◽  
Katarina Hedin ◽  
Pär-Daniel Sundvall
Keyword(s):  
Systematic Review ◽  
Sore Throat ◽  
Primary Healthcare ◽  
Malignant Disease ◽  
Meta Analysis ◽  
Acute Infection ◽  
Fusobacterium Necrophorum ◽  
Secondary Outcome ◽  
Case Control Studies ◽  
Group A

PurposeThe main objective of this review was to describe and quantify the association between Fusobacterium necrophorum (FN) and acute sore throat in primary healthcare (PHC).MethodsIn this systematic review and meta-analysis, we searched Scopus and PubMed for case–control studies reporting the prevalence of FN in patients attending primary care for an uncomplicated acute sore throat as well as in healthy controls. Only studies published in English were considered. Publications were not included if they were case studies, or if they included patients prescribed antibiotics before the throat swab, patients with a concurrent malignant disease, on immunosuppression, having an HIV infection, or patients having another acute infection in addition to a sore throat. Inclusion criteria and methods were specified in advance and published in PROSPERO. The primary outcome was positive etiologic predictive value (P-EPV), quantifying the probability for an association between acute sore throat and findings of FN in the pharynx. For comparison, our secondary outcome was the corresponding P-EPV for group A Streptococcus (GAS).ResultsPubMed and Scopus yielded 258 and 232 studies, respectively. Removing duplicates and screening the abstracts resulted in 53 studies subsequently read in full text. For the four studies of medium to high quality included in the meta-analysis, the cumulative P-EPV regarding FN was 64% (95% CI 33% to 83%). GAS, based on data from the same publications and patients, yielded a positive EPV of 93% (95% CI 83% to 99%).ConclusionsThe results indicate that FN may play a role in PHC patients with an acute sore throat, but the association is much weaker compared with GAS.

scholarly journals The high risk of malarial recurrence in patients with Plasmodium-mixed infection after treatment with antimalarial drugs: a systematic review and meta-analysis

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Aongart Mahittikorn ◽  
Frederick Ramirez Masangkay ◽  
Kwuntida Uthaisar Kotepui ◽  
Giovanni De Jesus Milanez ◽  
Manas Kotepui
Keyword(s):  
Systematic Review ◽  
Mixed Infection ◽  
Subgroup Analysis ◽  
Initial Treatment ◽  
Meta Analysis ◽  
Antimalarial Drugs ◽  
Secondary Outcome ◽  
Significant Heterogeneity ◽  
Pooled Prevalence ◽  
Significant Difference

Abstract Background Malaria mixed infections are often unrecognized by microscopists in the hospitals, and a delay or failure to treat Plasmodium-mixed infection may lead to aggravated morbidity and increased mortality. The present study aimed to quantify the pooled proportion and risk of malarial recurrences after the treatment of Plasmodium-mixed infection. The results of the study may provide benefits in the management of Plasmodium-mixed infection in co-endemic regions. Methods This systematic review and meta-analysis searched the international Prospective Register of Systematic Reviews (PROSPERO; ID = CRD42020199709), MEDLINE, Web of Science, and Scopus for potentially relevant studies in any language published between January 1, 1936, and July 20, 2020, assessing drug efficacy in patients with Plasmodium-mixed infection. The primary outcome was the pooled prevalence of Plasmodium parasitemia after initiating antimalarial treatment for Plasmodium-mixed infection. The secondary outcome was the pooled risk ratio (RR) of malarial recurrence in Plasmodium-mixed infection compared with those in Plasmodium falciparum and Plasmodium vivax mono-infection. The pooled analyses were calculated by random-effects meta-analysis. After the initial treatment in different days of recurrences (≤ 28 days or > 28 days), the risk of Plasmodium parasitemia was compared in subgroup analysis. Results Out of 5217 screened studies, 11 were included in the meta-analysis, including 4390 patients from six countries. The pooled prevalence of all recurrences of Plasmodium-mixed parasitemia was 30% (95% confidence interval (CI) 16–43; I2: 99.2%; 11 studies). The RR of malarial recurrence within 28 days after the initial treatment (clinical treatment failure) of Plasmodium-mixed parasitemia compared with the treatment of P. falciparum was 1.22 (p: 0.029; 95% CI 1.02–1.47; Cochran Q: 0.93; I2: 0%; six studies), while there was no significant difference in the risk of recurrence 28 days after initial treatment compared with the treatment of P. falciparum (p: 0.696, RR: 1.14; 95% CI 0.59–2.18; Cochran Q < 0.05; I2: 98.2%; four studies). The subgroup analysis of antimalarial drugs showed that significant malarial recurrence within 28 days was observed in patients treated with artemisinin-based combination therapies (ACTs) with no significant heterogeneity (p: 0.028, RR: 1.31; 95% CI 1.03–1.66; Cochran Q: 0.834; I2: 0%). Conclusions The present findings showed a high prevalence of malarial recurrence after the initial treatment of Plasmodium-mixed infection. Moreover, significant malaria recurrence of mixed infection occurred within 28 days after treatment with ACTs. Graphic Abstract

Triple versus LAMA/LABA combination therapy for Japanese patients with COPD: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Akira Koarai ◽  
Mitsuhiro Yamada ◽  
Tomohiro Ichikawa ◽  
Naoya Fujino ◽  
Tomotaka Kawayama ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Meta Analysis ◽  
Japanese Patients

scholarly journals Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis

Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 2065
Author(s):  
Irene Cortés-Pérez ◽  
Noelia Zagalaz-Anula ◽  
Desirée Montoro-Cárdenas ◽  
Rafael Lomas-Vega ◽  
Esteban Obrero-Gaitán ◽  
...  
Keyword(s):  
Systematic Review ◽  
Central Nervous System ◽  
Nervous System ◽  
Motor Function ◽  
Video Game ◽  
Meta Analysis ◽  
Leap Motion ◽  
Motion Controller ◽  
Motor Dexterity ◽  
Quality Evidence

Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility (SMD = 0.96; 95% CI = 0.47, 1.45). In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility (SMD = 1.34; 95% CI = 0.49, 2.19) and the UE mobility-oriented task (SMD = 1.26; 95% CI = 0.42, 2.10). Second, in patients with non-acute CNSD (cerebral palsy, multiple sclerosis, and Parkinson’s disease), LMC showed low-quality evidence of a medium effect on grip strength (GS) (SMD = 0.47; 95% CI = 0.03, 0.90) and on gross motor dexterity (GMD) (SMD = 0.73; 95% CI = 0.28, 1.17) in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD (SMD = 0.80; 95% CI = 0.06, 1.15) and fine motor dexterity (FMD) (SMD = 0.82; 95% CI = 0.07, 1.57). In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT.

scholarly journals Comparison of the clinical effectiveness of treatments for aromatase inhibitor-induced arthralgia in breast cancer patients: a protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033461
Author(s):  
Kyeore Bae ◽  
Si Yeon Song
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Pain Intensity ◽  
Aromatase Inhibitor ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Secondary Outcome ◽  
Breast Cancer Patients ◽  
Patient Reported

IntroductionAromatase inhibitor-induced arthralgia (AIA) is a major adverse event of aromatase inhibitors (AIs) and leads to premature discontinuation of AI therapy in breast cancer patients. The objective of this protocol for a systematic review and network meta-analysis (NMA) is to provide the methodology to compare the change in pain intensity between different AIA treatments and demonstrate the rank probabilities for different treatments by combining all available direct and indirect evidence.Methods and analysisPubMed, the Cochrane Controlled Register of Trials (CENTRAL), EMBASE, Web of Science and ClinicalTrials.gov will be searched to identify publications in English from inception to November 2019. We will include randomised controlled trials (RCTs) assessing the effects of different treatments for AIA in postmenopausal women with stage 0–III hormone receptor-positive breast cancer. The primary endpoints will be the change in patient-reported pain intensity from baseline to post-treatment. The number of adverse events will be presented as a secondary outcome.Both pairwise meta-analysis and NMA with the Frequentist approach will be conducted. We will demonstrate summary estimates with forest plots in meta-analysis and direct and mixed evidence with a ranking of the treatments as the P-score in NMA. The revised Cochrane risk-of-bias tool for randomised trials will be used to assess the methodological quality within individual RCTs. The quality of evidence will be assessed.Ethics and disseminationAs this review does not involve individual patients, ethical approval is not required. The results of this systematic review and NMA will be published in a peer-reviewed journal. This review will provide valuable information on AIA therapeutic options for clinicians, health practitioners and breast cancer survivors.PROSPERO registration numberCRD42019136967.

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