Different doses of gabapentin formulations for postherpetic neuralgia: A systematical review and meta-analysis of randomized controlled trials

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Abstract

Gabapentin, extended-release gabapentin (gabapentin ER), and gabapentin enacarbil (GEn), play an important role in relieving pain associated with postherpetic neuralgia (PHN). Although previous systematic reviews have assessed the efficacy and safety of gabapentin formulations for PHN, they have failed to take formulation differences and dose differences into account. Aiming at assessing the efficacy and safety of different doses of gabapentin formulations for PHN, this study performed a systematical review and meta-analysis of randomized controlled trials (RCTs).

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Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study.

S Maton, , Andrew S C Rice (2001)

A multicentre double blind, randomised, placebo controlled 7-week study evaluated the efficacy and safety of gabapentin 1800 or 2400 mg/day in treating postherpetic neuralgia. Three hundred and thirty-four men and women aged at least 18 years (mean 73) received gabapentin 1800 or 2400 mg daily or placebo in three divided doses with a forced titration schedule. The primary outcome measure was change in average daily pain diary score (baseline week v final week). Secondary outcomes included mean weekly sleep interference score; Short Form-McGill Pain Questionnaire (SF-MPQ); Clinician and Patient Global Impression of Change (CGIC/PGIC); Short Form-36 Health Survey (SF-36). From week 1, pain scores showed a significantly greater improvement with gabapentin: the final difference v baseline was -34.5% for the 1800 mg dose, -34.4% for the 2400 mg dose compared with -15.7% for the placebo group. The difference vs. placebo was 18.8% for the 1800 mg dose (95% confidence interval 10.9-26.8%; P 50% reduction in their pain intensity, in the CGIC and PGIC, in the sensory and total scores of the SF-MPQ (both doses), in the visual analogue scale of pain of the SF-MPQ (2400 mg only) and in the vitality, bodily pain and mental health domains of the SF-36. Overall gabapentin was well tolerated. The most common adverse events were dizziness and somnolence, particularly during the titration phase. Thus, this study confirms the role of gabapentin as an efficacious and well-tolerated treatment for postherpetic neuralgia.

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Epidemiology and treatment of neuropathic pain: the UK primary care perspective.

Dawn Carroll, Henry J McQuay, G. Hall … (2006)

The true incidence of neuropathic pain is unknown, but it is believed to be under-diagnosed and treated inadequately, despite the availability of drugs with proven efficacy. Our objective was to report the epidemiology and drug treatment of neuropathic pain as managed by UK primary care physicians. A descriptive analysis of the epidemiology of incident post-herpetic neuralgia (n=12,386); trigeminal neuralgia (8268); phantom limb pain (451) and painful diabetic neuropathy (4719) and prescription treatment at diagnosis from computerised UK general practice records (GPRD): January 1992 to April 2002. Incidences per 100,000 person years observation of 40 (95% CI 39-41) for post-herpetic neuralgia, 27 (26-27) for trigeminal neuralgia, 1 (1-2) for phantom limb pain and 15 (15-16) for painful diabetic neuropathy are reported, with rates decreasing over time for phantom limb pain and post-herpetic neuralgia and increasing for painful diabetic neuropathy. Drugs were initiated at first diagnosis record for 46-66% of conditions, usually one item, with antidepressants included in 30% of prescriptions, anticonvulsants in 20% and opioid analgesics in 20%. The most commonly prescribed items were the same across conditions; amitriptyline, carbamazepine, coproxamol, codydramol and codeine+paracetamol. Carbamazepine was prescribed to 58% of the trigeminal neuralgia cohort. In 2600 patients followed to stable therapy, there was a median of one to two drug changes. We provide the primary care managed incidence of four neuropathic pain conditions. For commonly prescribed treatments, changes in therapy are less frequent when initial therapy was with antidepressants or anticonvulsants rather than conventional analgesics.

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Cluster randomised trials in the medical literature: two bibliometric surveys

J Bland (2004)

Background Several reviews of published cluster randomised trials have reported that about half did not take clustering into account in the analysis, which was thus incorrect and potentially misleading. In this paper I ask whether cluster randomised trials are increasing in both number and quality of reporting. Methods Computer search for papers on cluster randomised trials since 1980, hand search of trial reports published in selected volumes of the British Medical Journal over 20 years. Results There has been a large increase in the numbers of methodological papers and of trial reports using the term 'cluster random' in recent years, with about equal numbers of each type of paper. The British Medical Journal contained more such reports than any other journal. In this journal there was a corresponding increase over time in the number of trials where subjects were randomised in clusters. In 2003 all reports showed awareness of the need to allow for clustering in the analysis. In 1993 and before clustering was ignored in most such trials. Conclusion Cluster trials are becoming more frequent and reporting is of higher quality. Perhaps statistician pressure works.