SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Pharmacoepidemiology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1614587
This article is part of the Research TopicNeuroimmune Interactions in Pain: From Central and Peripheral Neuroinflammation to Novel Therapeutic StrategiesView all articles
Efficacy and safety of different medications compared for the treatment of postherpetic neuralgia: a network meta-analysis
Provisionally accepted
- 1Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
- 2The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China, Hangzhou, Jiangsu Province, China
- 3Hangzhou ThirdPeople's Hospital Affiliated to Zhejiang Chinese Medical University,, Hangzhou, China
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Postherpetic neuralgia (PHN) is a neuropathic pain and the most common complication of herpes zoster (HZ). Pharmacotherapy serves as the primary intervention for alleviating pain associated with PHN. Methods: Electronic databases were systematically searched to identify randomized controlled trials (RCTs) evaluating pharmacotherapy for PHN. The network metaanalysis (NMA) based on the Bayesian framework was analyzed using R4.4.1 and Stata18.0 software. Results: A total of 38 RCTs were included in the analysis, enrolling 8,621 participants. In the Risk of Bias 2.0 (RoB 2.0) tool, 9 studies (24%)were assessed as having a high risk of bias, 15 studies (39%) were rated as having some concerns, and 14 studies (37%) were assessed as having a low risk of bias.The NMA results showed that the NGX-4010 8% capsaicin patch had a statistically significant effect in terms of pain intensity (MD = -9.20, 95% CI: [-12.0, -6.60]). The secondary outcomes showed a significant effect of hydromorphone in improving sleep quality (MD = -3.8, 95% CI: [-23.0, -15.0]) and decreasing pain questionnaire scores (MD = -13.0, 95% CI: [-28.0, 2.1]). Amitriptyline plus pregabalin demonstrated the highest probability of clinical superiority (SUCRA=0.92). The AE incidence results showed that opioids were identified as having the highest cumulative ranking (SUCRA=0.87). Conclusions: The study showed that capsaicin patches and hydromorphone were more significant in relieving pain in PHN, whereas calcium channel modulators were more comprehensive in clinical management. The inclusion of more high-quality articles was needed to support this evidence due to quality bias in the literature.
Keywords: postherpetic neuralgia, Herpes Zoster, Network meta-analysis, randomized controlled trial, Drug thearpy
Received: 19 Apr 2025; Accepted: 24 Jun 2025.
Copyright: © 2025 Guo, Xia and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zuyong Zhang, Hangzhou ThirdPeople's Hospital Affiliated to Zhejiang Chinese Medical University,, Hangzhou, China
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