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Meta-analysis of the usage of drugs affecting the central nervous system for uremic pruritus Metaanaliza badań dotyczących stosowania leków działających na ośrodkowy układ nerwowy w terapii świądu mocznicowego

Author(s): Anna Bogaczewicz | Tomasz Sobów | Jarosław Bogaczewicz | Anna Sysa-Jędrzejowska | Anna Woźniacka

Journal: Clinical Dermatology
ISSN 1730-7201

Volume: 13;
Issue: 2;
Start page: 69;
Date: 2011;
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Keywords: gabapentyna | nalfurafina | butorfanol | naltrekson | ondansetron | mirtazapina | doksepina | świąd

Introduction: Since pathogenesis of uremic pruritus is not fully elucidated, the treatment is a real challenge for a clinician. In case of the lack of treatment efficiency, despite the usage of emollients and phototherapy UV, one considers indications to the usage of drugs affecting the central nervous system, such as gabapentin, nalfurafine, butorphanol, naltrexone, ondansetron, mirtazapine and doxepin. Up to date there is a deficiency of randomized controlled trials (RCT) and meta-analyses concerning the usage of these medications. The aim of the study: To investigate efficiency of the usage of drugs affecting the central nervous system in the therapy of uremic pruritus based on the systematic review and meta-analysis of up-to-date studies. Material and methods: Randomized control trials (RCT) that investigated the usage of gabapentin, nalfurafine, butorphanol, naltrexone, ondansetron, mirtazapine, and doxepin in the treatment of uremic pruritus were enclosed to systematic review. A statistical analysis was performed using MetaEasy, version 1.0.4. Meta-analysis was carried out based on the mean difference (MD) and lower, and upper contingency interval (95% CI), in a random effects model. Results: The systematic review included 3 RCT of gabapentin therapy conducted in 84 patients with uremic pruritus, 1 meta-analysis and 1 RCT conducted in 268 patients undergoing nalfurafine therapy, 2 RTCs evaluating the usage of naltrexone in 31 patients, 1 RCT assessing ondansetron therapy in 16 patients, and 1 RCT assessing doxepin therapy in 24 patients. Gabapentin for the treatment of uremic pruritus was statistically more effective in comparison with placebo (MD=-2.32 [lower 95%CI=-2.97, upper 95%CI=-1.66] ). In comparison with placebo nalfurafine was found to be more effective in relieving uremic pruritus (MD=-0.49 [lower 95%CI=-0.66, upper 95%CI=-0.32]). One RCT showed significant decrease of pruritus in the group undergoing naltrexone therapy (p
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