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. 2024 Apr 5:11:1334944.
doi: 10.3389/fmed.2024.1334944. eCollection 2024.

Efficacy and safety of different systemic drugs in the treatment of uremic pruritus among hemodialysis patients: a network meta-analysis based on randomized clinical trials

Xueqian Zhao  1 , Haipeng Sun  1 , Wei Li  1
Affiliations

Efficacy and safety of different systemic drugs in the treatment of uremic pruritus among hemodialysis patients: a network meta-analysis based on randomized clinical trials

Xueqian Zhao et al. Front Med (Lausanne). .

Abstract

Aim: This network meta-analysis was to analyze and rank the efficacy and safety of different systemic drugs in the treatment of uremic pruritus (UP) among hemodialysis patients.

Method: PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to 10 July 2023 for randomized controlled trials (RCTs) investigating different drugs in the treatment of UP among hemodialysis patients. Drugs including cromolyn sodium, dexchlorpheniramine, difelikefalin, gabapentin, hydroxyzine, ketotifen, melatonin, montelukast, nalbuphine, nalfurafine, nemolizumab, nicotinamide, pregabalin, sertraline, thalidomide, and placebo were assessed. Outcome measures, including pruritus relief, response, and adverse events, were analyzed. Network plots, forest plots, league tables, and the surface under the cumulative ranking (SUCRA) probabilities were depicted for each outcome.

Results: The network meta-analysis retrieved 22 RCTs. Gabapentin (69.74%) had the highest likelihood to be the most effective drug for pruritus relief in UP patients receiving hemodialysis, followed by cromolyn sodium and hydroxyzine. Thalidomide (60.69%) and gabapentin (58.99%) were associated with significantly more drug responses for treating UP among patients receiving hemodialysis. Patients who were treated with gabapentin (40.01%) were likely to have risks of adverse events and dizziness. Lower risks of adverse events, nausea, and diarrhea were found in patients who received cromolyn sodium and lower risks of somnolence.

Conclusion: This study suggests considering gabapentin treatment when facing a patient suffering from UP. This study provides a reference for the selection of drug therapy for UP patients receiving hemodialysis.

Keywords: Bayesian; hemodialysis; network meta-analysis; systemic drugs; uremic pruritus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow diagram of the study selection.
Figure 2
Figure 2
Forest plot of the comparison of all drugs in pruritus relief for UP patients receiving hemodialysis.
Figure 3
Figure 3
Ranking probabilities of the comparison of effects and safety of all drugs for UP patients receiving hemodialysis.
Figure 4
Figure 4
Forest plot of the comparison of all drugs in drug response for UP patients receiving hemodialysis.
Figure 5
Figure 5
Forest plot of the comparison of all drugs in adverse events for UP patients receiving hemodialysis.
Figure 6
Figure 6
Forest plot of the comparison of all drugs in nausea for UP patients receiving hemodialysis.
Figure 7
Figure 7
Forest plot of the comparison of all drugs in diarrhea for UP patients receiving hemodialysis.
Figure 8
Figure 8
Forest plot of the comparison of all drugs in somnolence for UP patients receiving hemodialysis.
Figure 9
Figure 9
Forest plot of the comparison of all drugs in dizziness for UP patients receiving hemodialysis.
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