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抗抑郁药治疗腰痛和骨关节炎的疗效和安全性分析
作者:小柯机器人 发布时间:2021/1/24 20:06:19

澳大利亚悉尼大学Giovanni E Ferreira团队分析了抗抑郁药治疗腰痛和骨关节炎的疗效和安全性。2021年1月20日,该研究发表在《英国医学杂志》上。

为了比较抗抑郁药与安慰剂治疗腰背痛和骨关节炎疼痛的疗效和安全性,研究组在Medline、Embase、Cochrane中央对照试验注册中心、ClinicalTrials.gov等大型数据库中检索从建库到2020年11月15日的文献,筛选出比较任何抗抑郁药物与安慰剂(活性或惰性)对腰痛或颈痛、坐骨神经痛、髋关节或膝关节骨关节炎患者的疗效或安全性的随机对照试验,并进行系统回顾和荟萃分析。主要结局是疼痛和残疾,评分0-100,分数越高越严重;次要结局为安全性。

该研究共纳入33项试验,涉及5318名参与者。中等确定性证据表明,5-羟色胺-去甲肾上腺素再摄取抑制剂(SNRIs)在3-13周时可减轻背痛,低确定性证据表明,SNRIs在3-13周时可减轻骨关节炎疼痛。非常低的确定性证据表明,SNRIs在两周或更少的时间内可减少坐骨神经痛,但在3-13周却没有减轻。

低至极低的确定性证据表明,三环类抗抑郁药(TCA)在两周或更短时间内不会减少坐骨神经痛,但在3-13周和3-12个月会减少坐骨神经痛。中等确定性证据表明,SNRIs在3-13周时减少了背痛导致的残疾,在2周或更短时间内减少了骨关节炎导致的残疾,低确定性证据表明在3-13周时减少了相关残疾。TCAs和其他抗抑郁药不能减轻背痛引起的疼痛或残疾。

综上,中等确定性的证据表明,SNRIs对疼痛和残疾评分的影响很小,对背痛没有临床意义,但不能排除对骨关节炎有临床意义的影响。TCAs和SNRIs可能对坐骨神经痛有效,但证据的确定性从低到极低不等。

附:英文原文

Title: Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

Author: Giovanni E Ferreira, Andrew J McLachlan, Chung-Wei Christine Lin, Joshua R Zadro, Christina Abdel-Shaheed, Mary O’Keeffe, Chris G Maher

Issue&Volume: 2021/01/20

Abstract:

Objective To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo.

Design Systematic review and meta-analysis.

Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, International Pharmaceutical Abstracts, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to 15 November and updated on 12 May 2020.

Eligibility criteria for study selection Randomised controlled trials comparing the efficacy or safety, or both of any antidepressant drug with placebo (active or inert) in participants with low back or neck pain, sciatica, or hip or knee osteoarthritis.

Data extraction and synthesis Two independent reviewers extracted data. Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). A random effects model was used to calculate weighted mean differences and 95% confidence intervals. Safety (any adverse event, serious adverse events, and proportion of participants who withdrew from trials owing to adverse events) was a secondary outcome. Risk of bias was assessed with the Cochrane Collaboration’s tool and certainty of evidence with the grading of recommendations assessment, development and evaluation (GRADE) framework.

Results 33 trials (5318 participants) were included. Moderate certainty evidence showed that serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference 5.30, 95% confidence interval 7.31 to 3.30) at 3-13 weeks and low certainty evidence that SNRIs reduced osteoarthritis pain (9.72, 12.75 to 6.69) at 3-13 weeks. Very low certainty evidence showed that SNRIs reduced sciatica at two weeks or less (18.60, 31.87 to 5.33) but not at 3-13 weeks (17.50, 42.90 to 7.89). Low to very low certainty evidence showed that tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less (7.55, 18.25 to 3.15) but did at 3-13 weeks (15.95, 31.52 to 0.39) and 3-12 months (27.0, 36.11 to 17.89). Moderate certainty evidence showed that SNRIs reduced disability from back pain at 3-13 weeks (3.55, 5.22 to 1.88) and disability due to osteoarthritis at two weeks or less (5.10, 7.31 to 2.89), with low certainty evidence at 3-13 weeks (6.07, 8.13 to 4.02). TCAs and other antidepressants did not reduce pain or disability from back pain.

Conclusion Moderate certainty evidence shows that the effect of SNRIs on pain and disability scores is small and not clinically important for back pain, but a clinically important effect cannot be excluded for osteoarthritis. TCAs and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low.

DOI: 10.1136/bmj.m4825

Source: https://www.bmj.com/content/372/bmj.m4825

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj