Do individualized medication effectiveness tests (n-of-1 trials) change clinical decisions about which drugs to use for osteoarthritis and chronic pain?
Do individualized medication effectiveness tests (n-of-1 trials) change clinical decisions about which drugs to use for osteoarthritis and chronic pain?
复制标题
DOI：
10.1097/00045391-200501000-00012
复制
发表时间：
2005-01-01
影响因子：
4.2
通讯作者：
Del Mar, Chris
中科院分区：
文献类型：
--
作者：
Nikles, C Jane;Yelland, Michael;Del Mar, Chris
评估个体化药物有效性测试（IMET，或 n-of-1 试验）对患者关于慢性疼痛药物的短期决策的影响。对在 3 对治疗期内使用扑热息痛和布洛芬进行药物与安慰剂、药物与药物或药物与药物组合的双盲、交叉比较的患者进行调查评估，随机配对。患有慢性疼痛（≥3 个月）或骨关节炎（疼痛≥1 个月）的全科患者（由 2 个三级疼痛诊所补充）严重到需要考虑长期使用非甾体抗炎药 (NSAID)，但对 NSAID 或替代药物的疗效存有疑问。患者指定部位的疼痛和僵硬、全身疼痛、逃避镇痛的使用以及副作用。在已启动的 116 个 IMET 中，有 71 个已完成。 71 名中的 46 名（65%）的药物管理发生了变化。最常见的改变是添加扑热息痛或用扑热息痛替代 NSAID 或 COX-2 抑制剂（71 名患者中的 25 名，占改变的 54%）。在 IMET 之前使用 NSAID 或 COX-2 抑制剂的 37 人中，12 人 (32%) 在之后停止了这些药物。在直接比较这些药物的 54 项 IMET 中，有 37 项 (68%) 扑热息痛与布洛芬一样有效或更有效。 IMET 为临床决策提供有用的信息。扑热息痛对于最佳药物选择存在疑问的慢性疼痛患者仍然有用。我们的研究结果为众所周知的对乙酰氨基酚作为慢性疼痛一线治疗的建议提供了新的（个人）视角，并证明通过邮件和电话在全国范围内提供 IMET 是可行的。
To assess the impact of individualized medication effectiveness tests (IMETs, or n-of-1 trials), on patients' short-term decision making about medications for chronic pain. Survey evaluation of patients undergoing a double-blind, crossover comparison of drug versus placebo, drug versus drug, or drug versus drug combination using paracetamol and ibuprofen in 3 pairs of treatment periods, randomized within pairs. General practice patients (supplemented by a few from 2 tertiary pain clinics) with either chronic pain (> or =3 months), or osteoarthritis (with pain for > or =1 month) severe enough to warrant consideration of long-term nonsteroidal antiinflammatory drug (NSAID) use but for whom there was doubt about the efficacy of NSAID or alternative. Pain and stiffness in sites nominated by the patient, global pain, use of escape analgesia, and side effects. Of 116 IMETs started, 71 were completed. Drug management changed for 46 of 71 (65%). The most common change was to add paracetamol or to substitute the NSAID or COX-2 inhibitor with paracetamol (25 of 71 patients and 54% of changes). Of the 37 who were using NSAIDs or COX-2 inhibitors before the IMET, 12 (32%) ceased these afterward. Paracetamol was as effective or more effective than ibuprofen in 37 (68%) of the 54 IMETs directly comparing these drugs. IMETs provide useful information for clinical decisions. Paracetamol continues to be useful for patients with chronic pain whose optimal drug choice is in doubt. Our results provide a new (individual) perspective on the well-known recommendation for paracetamol as first-line treatment for chronic pain and demonstrate that it is feasible to provide IMETs nationally by mail and telephone.