Table 12GRADE profiles – SNRIs as monotherapy for neuropathic pain

No. of studiesDesignTreatmentPlaceboRelative risk (95% CI)
[ARR]
[NNTB, 95% CI]
LimitationsInconsistencyIndirectnessImprecisionOther considerationsQuality
PRIMARY Outcome: Patient-reported 30% pain reduction
1
(Dulo1)
RCT146/221
(66.1%)
44/106
(41.5%)
1.59 (1.25, 2.03)
ARR = 24.6%
NNTB = 4.1 (2.8, 7.6)
NNNSbNModerate
PRIMARY Outcome: Patient-reported 50% pain reduction
4
(3×Dulo 13)
(1×Ven4)
RCT505/945
(53.4%)
136/411
(33.1%)
1.65 (1.42, 1.91)
ARR = 20.3%
NNTB = 4.9 (3.9, 6.8)
NNNNNHigh
PRIMARY Outcome: Patient-reported global improvement/impression of changea
2
(Ven 5,6)
RCT28/69
(40.6%)
10/52
(19.2%)
1.89 (0.65, 5.52)
ARR = 21.4%
NNTB = N/A
NNNScNModerate
No. of studiesDesignTreatmentPlaceboRelative risk
[ARI]
[NNTH]
LimitationsInconsistencyIndirectnessImprecisionOther considerationsQuality
PRIMARY Outcome: No. of withdrawals owing to adverse effects
7
(3×Dulo 13)
(4×Ven 4,5,6,7)
RCT132/1066
(12.4%)
29/524
(5.5%)
2.34 (1.59, 3.44)
ARI = 6.9%
NNTH = 14.6 (10.4, 24.6)
NNNSdNModerate
PRIMARY Outcome: Dry mouth (adverse effects)
3
(1×Dulo2)
(2×Ven 5,7)
RCT55/406
(13.5%)
28/179
(15.6%)
1.26 (0.86, 1.85)
ARI = −2.1%
NNTH = N/A
NNNVSfNLow
PRIMARY Outcome: Blurred vision (adverse effects)
1
(Ven5)
RCT1/33
(3.0%)
0/33
(0.0%)
3.00 (0.13, 71.07)
ARI = 3.0%
NNTH = N/A
NNNVSeNVery low
PRIMARY Outcome: Dizziness (adverse effects)
3
(2×Dulo 1,2)
(1×Ven5)
RCT76/601
(12.6%)
15/256
(5.9%)
2.06 (1.21, 3.52)
ARI = 6.7%
NNTH = 14.7 (9.3, 34.8)
NNNVSfNLow
PRIMARY Outcome: Vomiting (adverse effects)
1
(Ven4)
RCT9/164
(5.5%)
0/81
(0.0%)
9.44 (0.56, 160.24)
ARI = 5.5%
NNTH = N/A
NNNVSeNVery low
PRIMARY Outcome: gastrointestinal disturbances (adverse effects)
2

(1×Dulo1)
(1×Ven5)
RCT21/259
(8.1%)
5/141
(3.5%)
2.57 (0.93, 7.10)
ARI = 4.6%
NNTH = N/A
NNNVSfNLow
PRIMARY Outcome: Any adverse effects: non-specified
1
(Ven7)
RCT23/40
(57.5%)
11/20
(50.0%)
1.05 (0.65, 1.69)
ARI = 7.5%
NNTH = N/A
NNNVSeNVery low

N = No serious; S = Serious; VS = Very serious

Dulo = duloxetine; Ven = venlafaxine; N/A = not applicable

a

Categorical scales for patient-reported global improvement/impression of change were dichotomised for analysis. For examples, ‘at least moderate improvement’ on a 6-item scale, ‘at least good improvement’ on a 5-item scale or ‘much or very much improved’ on the patients' global impression of change (PGIC) scale were the cut-offs for dichotomisation.

b

Total number of events (positive outcomes) less than 300.

c

Total number of events (positive outcomes) less than 300 owing to small study sample.

d

GDG consensus: Total number of adverse effects less than 300, downgrade 1 level.

e

GDG consensus: if there is only 1 study with total number of adverse effects less than 100, the GDG decided that the quality should be graded as ‘very low’.

f

GDG consensus: Total number of adverse effects less than 100, downgrade quality by 2 levels.

1
2
3
4
5
6
7

From: 2, How this guideline was developed

Cover of Neuropathic Pain
Neuropathic Pain: The Pharmacological Management of Neuropathic Pain in Adults in Non-Specialist Settings.
NICE Clinical Guidelines, No. 96.
Centre for Clinical Practice at NICE (UK).
Copyright © 2010, National Institute for Health and Clinical Excellence.

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