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Table 2Overview of head-to-head trials of skeletal muscle relaxants for spasticity

Interventions DoseStudy Year QualityPopulation Number enrolledMain outcomes assessedMain resultsWithdrawal (overall)s
Tizanidine versus baclofen
Tizanidine mean 17 mg/dayBass 198872Multiple sclerosisSpasticity: 6 point scale
Strength: 6 point scale
Functional status: Kurtzke functional scale
Disability: Pedersen functional disability scale
Preference: patient assessment
No significant differences between interventions for main outcomes10% (5/52)
Baclofen mean 35 mg/dayFAIR6627% (13/48)
Tizanidine mean 22 mg/dayCorston 198150Lower limb spasticity due to various causesSpasticity: 3 point scale
Strength: 5 point scale
General mobility: 3 point scale
Urinary frequency: 3 point scale
Gait: 3 point scale
No significant differences between interventions for main outcomesNone reported
Baclofen mean 40 mg/dayFAIR10
Tizanidine titrated to 24 mg/dayEyssette 198873Multiple sclerosisSpasticity: 5 point scale
Stretch reflex: 1–5 scale
Functional status: Unspecified methods
Efficacy and tolerability: Unspecified methods
No significant differences between interventions16% (8/50)
Baclofen titrated to 60 mg/dayFAIR10012% (6/50)
Tizanidine 12–24 mg/dayHoogstraten 198874Multiple sclerosisSpasticity: Ashworth scale and patient self-report (5 point scale)
Disability: Kurtzke Expanded
Disability Status Scale
Functional status: Kurtzke Functional Systems
Incapacity status: Minimal record of disability for multiple sclerosis
Ambulation: Ambulation index Clonus and reflexes: Unspecified methods
Muscle strength and pain: 5 point scales
Efficacy and tolerance: −3 to +3 scales
No significant differences between interventions (Ashworth scale scores not reported)6% (1/16)
Baclofen 15–60 mg/dayFAIR1625% (4/16)
Tizanidine mean 20 mg/dayMedici 198975Spasticity due to various causesSpasticity: Ashworth scale and patient self-report (4 point scale)
Muscle strength: 5 point scale
Clonus: 3 point scale
Functional status: Kurtzke Expanded Disability Status Scale
Global assessments: Unspecified methods
No significant differences between interventions (Ashworth scale scores not reported)7% (1/15)
Baclofen mean 50 mg/dayFAIR3027% (4/15)
Tizanidine titrated to 16 mg/dayNewman 198276Multiple sclerosis (32) or syringomyelia (4)Spasticity: Ashworth scale
Functional status: Kurtzke and Pedersen scales
No significant differences between interventions (Ashworth scale scores not reported)11% (4/36)
Baclofen titrated to 40 mg/dayFAIR3617% (6/36)
Tizanidine mean 11 mg/dayRinne 1980 (2)71Multiple sclerosis (24) or cervical myelopathy (8)Spasticity: Ashworth scaleNo significant differences between interventions (Ashworth scale scores not reported)6% (1/16)
Baclofen mean 51 mg/dayFAIR326% (1/16)
Tizanidine 8 mg tidSmolenski 198177Multiple sclerosisTone: Ashworth scale
Spasticity: 5 point scale
Muscle strength: 6 point scale
Global assessment of change in condition: Unspecified methods
Tolerance to medication: Unspecified methods
No significant differences between interventions (Ashworth scale scores not reported)None reported
Baclofen 20 mg tidFAIR21
Tizanidine mean 23 mg/dayStien 198764Multiple sclerosisTone/spasticity: Ashworth scale
Functional status: Kurtzke Expanded Disability Status Scale
Functional assessment: Pederson scale
No significant differences between interventions (Ashworth scale scores not reported)6% (1/18)
Baclofen mean 59 mg/dayFAIR405% (1/20)
Tizanidine, baclofen, or dantrolene versus diazepam
Tizanidine mean 17 mg/dayBes 198878Post-stroke or head-traumaSpasticity: 5 point scale
Functional status: walking distance
Severity of spasms: 5 point scale
Muscle strength: Unspecified methods
Clonus: Unspecified methods
No significant differences between interventions12% (6/51)
Diazepam mean 20 mg/dayFAIR10531% (17/54)
Tizanidine mean 14 mg/dayRinne 1980 (1)71Multiple sclerosisSpasticity: Ashworth scaleNo significant differences between interventions (Ashworth scale scores not reported)0% (0/15)
Diazepam mean 15 mg/dayFAIR3027% (4/15)
Baclofen 30 mg/day and 60 mg/dayCartlidge 197479Multiple sclerosisSpasticity: Ashworth scaleNo significant differences between interventions (mean Ashworth score improvement 0.227 vs. 0.202 on high-doses)Not clear
Diazepam 15 mg/day and 30 mg/dayFAIR40
Baclofen mean 61 mg/dayFrom 197581Multiple sclerosis inpatientsSpasticity: Ashworth scale, clinical exam (unspecified methods)
Clinical assessments of spasms, clonus, bladder function, walking: Unspecified methods
Patient preference
No significant differences between interventions (Ashworth scale scores not reported)6% (1/16)
Diazepam mean 27 mg/dayFAIR160% (0/16)
Baclofen mean 47 mg/dayRoussan 198580Spasticity due to various causesGlobal response to treatment: 0 (no improvement) to 3+ (marked improvement)No significant differences between interventionsNone reported
Diazepam 28mg/dayFAIR13
Dantrolene 100 mg qidGlass 197482Spasticity due to various causesSpasticity/tone: 6 point scale
Reflexes: 6 point scale
Clonus: 6 point scale
Strength: 6 point scale
No significant differences between interventions19% (3/16)
Diazepam 5 mg qidFAIR166% (1/16)
Dantrolene titrated to 75 mg qidNogen 197683Children with cerebral palsyTone: Unspecified method
Tendon jerk: Unspecified method
Clonus: Unspecified method
Strength: Unspecified method
Overall evaluation: Unspecified method
No significant differences between interventionsNone reported
Diazepam titrated to 12 mg/dayFAIR22
Dantrolene titrated to 75 mg qidSchmidt 197684Multiple sclerosisSpasticity: 6 point scale
Clonus: 6 point scale
Reflexes: 6 point scale
Functional status: Methods not specified, derived from ACTH cooperative study
No significant differences between interventions for spasticity or clonus. Reflexes, station stability, and hand coordination favor dantrolene.Not clear
Diazepam titrated to 5 mg qidFAIR46
Baclofen versus clonidine
Baclofen 20 mg qidNance 199485Spinal cord injurySpasticity: modified Ashworth scale (1–5 scale with 0.5 gradations)No significant differences between interventions for spasticity.None reported
Clonidine 0.05 mg bidPOOR25

From: Results

Cover of Drug Class Review: Skeletal Muscle Relaxants
Drug Class Review: Skeletal Muscle Relaxants: Final Report [Internet].
Chou R, Peterson K.
Portland (OR): Oregon Health & Science University; 2005 May.
Copyright © 2005, Oregon Health & Science University, Portland, Oregon.

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