Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis.
Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis.
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DOI：
10.1136/bmj.m4825
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发表时间：
2021-01-20
期刊：
影响因子：
--
通讯作者：
Maher CG
中科院分区：
文献类型：
--
作者：
Ferreira GE;McLachlan AJ;Lin CC;Zadro JR;Abdel-Shaheed C;O'Keeffe M;Maher CG
研究与安慰剂相比，抗抑郁药治疗背痛和骨关节炎疼痛的有效性和安全性。系统回顾和荟萃分析. Medline、Embase、科克伦对照试验中心注册中心、CINAHL、国际药物文摘、ClinicalTrials.gov和世界卫生组织国际临床试验注册平台（自成立至2020年11月15日，并于2020年5月12日更新）。比较任何抗抑郁药物与安慰剂（活性或惰性）在腰痛或颈痛、坐骨神经痛或髋关节或膝关节骨关节炎受试者中的疗效或安全性或两者的随机对照试验。两位独立的审查员提取了数据。疼痛和残疾是主要结局。将疼痛和残疾评分转换为0（无疼痛或残疾）至100（最严重疼痛或残疾）的量表。使用随机效应模型计算加权平均差异和95%置信区间。安全性（任何不良事件、严重不良事件和因不良事件退出试验的受试者比例）是次要结局。使用科克伦协作网的工具评估偏倚风险，并使用推荐分级评估、开发和评价（GRADE）框架评估证据的确定性。纳入33项试验（5318例受试者）。中度确定性证据表明，在3- 13周时，阿托宁-去甲肾上腺素再摄取抑制剂（SNRI）可减轻背痛（平均差异为−5.30，95%置信区间为−7.31至−3.30），低确定性证据表明SNRI可减轻骨关节炎疼痛（−9.72，−12.75至−6.69）。非常低的确定性证据表明，SNRIs在两周或更短时间内（-18.60，-31.87至-5.33）减少坐骨神经痛，但在3-13周（-17.50，-42.90至7.89）没有。低到非常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（−7.55，−18.25至3.15）不会减轻坐骨神经痛，但在3-13周（−15.95，−31.52至−0.39）和3-12个月（−27.0，−36.11至−17.89）时会减轻坐骨神经痛。中度确定性证据表明，SNRI在3-13周（-3.55，-5.22至-1.88）降低了背痛的残疾，在2周或更短时间内（-5.10，-7.31至-2.89）降低了骨关节炎的残疾，在3-13周（-6.07，-8.13至-4.02）降低了低确定性证据。TCA和其他抗抑郁药并不能减轻背痛引起的疼痛或残疾。中等确定性证据表明，SNRI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。TCA和SNRI可能对坐骨神经痛有效，但证据的确定性从低到非常低不等。PROSPERO CRD 42020158521。
To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo. Systematic review and meta-analysis. 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. 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. 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. 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. 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. PROSPERO CRD42020158521.
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