The Efficacy and Safety of Pharmacological Treatments for Restless Legs Syndrome: Systemic Review and Network Meta-Analysis.
The Efficacy and Safety of Pharmacological Treatments for Restless Legs Syndrome: Systemic Review and Network Meta-Analysis.
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不宁腿综合征药物治疗的有效性和安全性：系统评价和网络荟萃分析
DOI：
10.3389/fnins.2021.751643
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发表时间：
2021
影响因子：
4.3
通讯作者：
Chen L
中科院分区：
文献类型：
--
作者：
Zhou X;Du J;Liang Y;Dai C;Zhao L;Liu X;Tan C;Mo L;Chen L
目前临床上治疗不宁腿综合征的药物种类繁多，但选择合适的药物仍存在一定的困难。该网络荟萃分析（NMA）旨在比较不同药物的疗效和安全性。经过文献检索和筛选，46项试验，包括10，674例受试者被纳入本NMA。汇总结果显示，与安慰剂相比，仅左旋多巴对缓解RLS症状无效。在所有药物中，卡麦角林降低IRLS评分的程度最大（MD −11.98，95% CI −16.19至−7.78）。此外，在缓解RLS症状方面，普拉克索上级优于罗匹尼罗（MD −2.52，95% CI −4.69至−0.35）。此外，与安慰剂相比，铁补充剂显著减轻了缺铁患者的RLS症状（MD-5.15，95%CI-8.99至-1.31），但对于血清铁蛋白水平正常的RLS患者则没有（MD-2.22，95%CI-6.99至2.56）。对于原发性RLS，这些药物也有效，而对于继发性RLS，分析药物疗效的数据不足。我们分析了药物常见不良反应的风险，包括恶心、嗜睡、疲劳、头痛和鼻咽炎。α-2-δ配体和DA是原发性和继发性RLS的有利选择，因为它们具有显著的疗效和良好的耐受性。补铁治疗能明显缓解RLS缺铁患者的症状。我们推荐加巴喷丁、加巴喷丁依那卡比和普瑞巴林作为临床医生的首选药物，主要是因为它们很少引起隆乳。重度或极重度RLS患者经上述药物治疗无效，可考虑使用羟考酮-纳洛酮。
Although various drugs are currently used for restless legs syndrome (RLS) in clinic, selecting appropriate drugs for patients is difficult. This network meta-analysis (NMA) aimed to compare the efficacy and safety of different drugs. After literature searching and screening, 46 trials, including 10,674 participants are included in this NMA. The pooled results showed that, compared with placebo, only levodopa is inefficient to relieve symptoms of RLS. Cabergoline decreases IRLS scores to the greatest extent among all drugs (MD −11.98, 95% CI −16.19 to −7.78). Additionally, pramipexole is superior to ropinirole in alleviating symptoms of RLS (MD −2.52, 95% CI −4.69 to −0.35). Moreover, iron supplement alleviates RLS symptoms significantly compared with placebo in patient with iron deficiency (MD −5.15, 95% CI −8.99 to −1.31), but not for RLS patients with normal serum ferritin level (MD −2.22, 95% CI −6.99 to 2.56). For primary RLS, these drugs are also effective, while there is insufficient data to analyze drug efficacy in secondary RLS. We analyzed risk of common adverse effects of drugs including nausea, somnolence, fatigue, headache and nasopharyngitis. Alpha-2-delta ligands and DAs are favorable choices for both primary and secondary RLS because of their significant efficacy and good tolerability. Iron supplement can significantly alleviate symptoms of RLS patients with iron deficiency than placebo. We recommend gabapentin, gabapentin enacarbil, and pregabalin for clinicians for first consideration mainly because that they rarely cause augmentation. Oxycodone-naloxone could be considered in patients with severe or very severe RLS who failed in treatment with above drugs.
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影响因子：
2.9
作者：
Cundy, Kenneth C.;Sastry, Srikonda;Canafax, Daniel M.
通讯作者：
Canafax, Daniel M.
影响因子：
3.4
作者：
Braun, Marina;Cawello, Willi;Horstmann, Rolf
通讯作者：
Horstmann, Rolf
影响因子：
--
作者：
Allen, RP;Walters, AS;Ferini-Strambi, L
通讯作者：
Ferini-Strambi, L
影响因子：
5.6
作者：
Benes, H;Heinrich, CR;Kohnen, R
通讯作者：
Kohnen, R
影响因子：
4.8
作者：
Ferini-Strambi, L.
通讯作者：
Ferini-Strambi, L.