Effectiveness and Safety of Mecobalamin on Herpetic Neuralgia: A Systematic Review and Meta-analysis of Randomized Controlled Trials
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Abstract
Objectives: To determine the effectiveness and safety of mecobalamin on herpetic neuralgia. Method: The researchers searched published reports through electronic databases including Pubmed, EMBASE, Scopus, CINAHL, Cochrane Library, Web of Science, www.ClinicalTrials.gov, and databases in Thailand from inception to Feb 2018. The researchers selected the randomized controlled trials investigating the effects of mecobalamin on patients with herpetic neuralgia. The primary outcome was pain score while the secondary outcomes were the proportion of patients with improvement of overall pain more than 30% (success rate) and adverse events. All analyses employed employed random effect model and reported Weighted Mean Difference (WMD) and Relative Risk (RR) with confident interval 95% (95%CI). Primary analysis was meta-analysis (classical) while secondary analysis was network meta-analysis according to frequentist framework and estimated Surface Under the Cumulative Ranking (SUCRA) of various drugs with Bayesian statistics. Result: The search identified a total of 462 related studies but 5 studies were included in this study. These studies determined the effects of both monotherapy and combination therapy of mecobalamin for 2-4 weeks in 498 patients with herpetic neuralgia. Three of 5 studies had high risk of bias as assessed using the Cochrane Risk of Bias (ROB) 2.0. Meta-analysis showed that mecobalamin injection decreased pain score more than lidocane did (WMD=3.11, 95%CI; 2.53-3.70) and success rate of mecobalamin was significantly higher than those of lidocaine (RR =3.70, 95%CI: 2.22-6.25). Results from network meta-analysis showed that success rate of mecobalamine monotherapy and mecobalamin combination were statistically significant higher than those of lidocaine group (RR = 3.69, 95%CI: 2.21-6.18 and RR= 4.27, 95%CI: 2.50-7.32, respectively). No serious adverse events were reported. Conclusion: Current evidence indicates that monotherapy of mecobalamin injection or combined use of mecobalamin with other therapies may be effective and safe for treatment of herpetic neuralgia. However, further studies with a large sample size and high quality design are needed to confirm this conclusion.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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