SynthesisJournal of general internal medicine2009
Gabapentin versus tricyclic antidepressants for diabetic neuropathy and post-herpetic neuralgia: discrepancies between direct and indirect meta-analyses of randomized controlled trials.
Synthesis in Journal of general internal medicine, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 18 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 6 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Preoperative Oral Gabapentin in the Management of Postoperative Catheter-Related Bladder Discomfort in Adults: A Systematic Review and Meta-Analysis.Frontiers in surgery · 2021Pooled it
- Updating the evidence on drugs to treat overactive bladder: a systematic review.International urogynecology journal · 2019Pooled it
- Gabapentin for chronic neuropathic pain in adults.The Cochrane database of systematic reviews · 2017Pooled it
- Gabapentin for chronic neuropathic pain and fibromyalgia in adults.The Cochrane database of systematic reviews · 2014Pooled it
- Gabapentin for chronic neuropathic pain and fibromyalgia in adults.The Cochrane database of systematic reviews · 2011Pooled it
- Postherpetic neuralgia.BMJ clinical evidence · 2010Pooled it
- Cost effectiveness of a lidocaine 5% medicated plaster compared with pregabalin for the treatment of postherpetic neuralgia in the UK: a Markov model analysis.Clinical drug investigation · 2010Trial
- Neuropathy in Human Immunodeficiency Virus: A Review of the Underlying Pathogenesis and Treatment.Cureus · 2022Review
- Pharmacotherapy of Painful Diabetic Neuropathy: A Clinical Update.Sisli Etfal Hastanesi tip bulteni · 2022Review
- Updating the Comparative Evidence on Second-Generation Antipsychotic Use With Schizophrenia.Psychiatric research and clinical practice · 2020Article
- Review
- Gabapentinoid Insensitivity after Repeated Administration is Associated with Down-Regulation of the α(2)δ-1 Subunit in Rats with Central Post-Stroke Pain Hypersensitivity.Neuroscience bulletin · 2016Article
- Diabetic neuropathic pain: Physiopathology and treatment.World journal of diabetes · 2015Review
- Post-herpetic neuralgia.International journal of general medicine · 2012Article
- Review
- Gabapentin versus tricyclics for neuropathic pain.Journal of general internal medicine · 2009Article
- Comparative Efficacy and Safety of Clonazepam versus Nortriptyline in Restless Leg Syndrome among Forty Plus Women: A Prospective, Open-Label Randomized Study.Journal of mid-life healthArticle
- Characterization of Internal Validity Threats to Phase III Clinical Trials for Chemotherapy-Induced Peripheral Neuropathy Management: A Systematic Review.Asia-Pacific journal of oncology nursingReview
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrevious systematic reviews concluded that tricyclics antidepressants are superior to gabapentin for neuropathic pain, but were based on indirect comparisons from placebo-controlled trials. PURPOSE: To evaluate gabapentin versus tricyclic antidepressants for diabetic neuropathy and post-herpetic neuralgia, using direct and indirect comparisons. DATA SOURCES: MEDLINE (1966 to March Week 4 2008), the Cochrane central register of controlled trials (1st quarter 2008), and reference lists. STUDY SELECTION: We selected randomized trials directly comparing gabapentin versus tricyclic antidepressants or comparing either of these medications versus placebo. DATA EXTRACTION: Studies were reviewed, abstracted, and quality-rated by two independent investigators using predefined criteria. DATA SYNTHESIS: We performed a meta-analysis of head-to-head trials using a random effects model and compared the results to an adjusted indirect analysis of placebo-controlled trials.
resultsIn three head-to-head trials, there was no difference between gabapentin and tricyclic antidepressants for achieving pain relief (RR 0.99, 95% CI 0.76 to 1.29). In adjusted indirect analyses, gabapentin was worse than tricyclic antidepressants for achieving pain relief (RR = 0.41, 95% CI 0.23 to 0.74). The discrepancy between direct and indirect analyses was statistically significant (p = 0.008). Placebo-controlled tricyclic trials were conducted earlier than the gabapentin trials, reported lower placebo response rates, had more methodological shortcomings, and were associated with funnel plot asymmetry.
conclusionsThough direct evidence is limited, we found no difference in likelihood of achieving pain relief between gabapentin and tricyclic antidepressants for diabetic neuropathy and post-herpetic neuralgia. Indirect analyses that combine data from sets of trials conducted in different eras can be unreliable.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.