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Meta-Analysis
. 2010 Dec 28;5(12):e14433.
doi: 10.1371/journal.pone.0014433.

Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials

Tudor J C Phillips  1 , Catherine L Cherry, Sarah Cox, Sarah J Marshall, Andrew S C Rice
Affiliations
Meta-Analysis

Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials

Tudor J C Phillips et al. PLoS One. .

Abstract

Background: Significant pain from HIV-associated sensory neuropathy (HIV-SN) affects ∼40% of HIV infected individuals treated with antiretroviral therapy (ART). The prevalence of HIV-SN has increased despite the more widespread use of ART. With the global HIV prevalence estimated at 33 million, and with infected individuals gaining increased access to ART, painful HIV-SN represents a large and expanding world health problem. There is an urgent need to develop effective pain management strategies for this condition.

Objective: To evaluate the clinical effectiveness of analgesics in treating painful HIV-SN.

Design: Systematic review and meta-analysis.

Data sources: Medline, Cochrane central register of controlled trials, www.clinicaltrials.gov, www.controlled-trials.com and the reference lists of retrieved articles.

Selection criteria: Prospective, double-blinded, randomised controlled trials (RCTs) investigating the pharmacological treatment of painful HIV-SN with sufficient quality assessed using a modified Jadad scoring method.

Review methods: Four authors assessed the eligibility of articles for inclusion. Agreement of inclusion was reached by consensus and arbitration. Two authors conducted data extraction and analysis. Dichotomous outcome measures (≥ 30% and ≥ 50% pain reduction) were sought from RCTs reporting interventions with statistically significant efficacies greater than placebo. These data were used to calculate RR and NNT values.

Results: Of 44 studies identified, 19 were RCTs. Of these, 14 fulfilled the inclusion criteria. Interventions demonstrating greater efficacy than placebo were smoked cannabis NNT 3.38 95%CI(1.38 to 4.10), topical capsaicin 8%, and recombinant human nerve growth factor (rhNGF). No superiority over placebo was reported in RCTs that examined amitriptyline (100mg/day), gabapentin (2.4 g/day), pregabalin (1200 mg/day), prosaptide (16 mg/day), peptide-T (6 mg/day), acetyl-L-carnitine (1g/day), mexilitine (600 mg/day), lamotrigine (600 mg/day) and topical capsaicin (0.075% q.d.s.).

Conclusions: Evidence of efficacy exists only for capsaicin 8%, smoked cannabis and rhNGF. However,rhNGF is clinically unavailable and smoked cannabis cannot be recommended as routine therapy. Evaluation of novel management strategies for painful HIV-SN is urgently needed.

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Conflict of interest statement

Competing Interests: ASCR has received fees and associated expenses for research-related consultancy services contracted via Imperial College Consultants from Pfizer, Eisai, Solvay, Spinifex, Organon, Lectus Astellas, Allergan, GSK, NeuroGsx, Esteve and Daiichi Sankyo. ASCR is a member of the EU funded Innovative Medicines Initiative grant “Europain” in which a number of pharmaceutical companies are also participating: Astra-Zeneca, Esteve, Boehinger-Ingelheim, Pfizer, Eli Lilly, GlaxoSmithKline, Wyeth, UCB and Sanofi Aventis. ASCR has also received a research grant from Pfizer; CLC has had investigator initiated research grants from GlaxoSmithKline, Roche Australia and Zymes LLC; CLC is also on the advisory boards of Gilead Science and BMS Australia Virology, honoraria for both have been donated to charity. CLC undertakes consultancy work and is a principle investigator on two clinical studies for CNS Bio; TJCP, SM and SC have no financial interests that may be relevant to the submitted work. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. PRISMA flow diagram of included randomized controlled trials.
See this image and copyright information in PMC

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