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Gabapentinoids for chemotherapy-induced peripheral neuropathy: systematic review and meta-analysis
  1. Tsung Wei Chang1,
  2. Fu-Yu Yang1,
  3. Yu-Chang Liu2,3 and
  4. Cheng-Hsien Hung4
  1. 1Pharmacy, Yuanlin Christian Hospital, Changhua, Taiwan
  2. 2Department of Radiation Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan
  3. 3Department of Medical Imaging and Radiologic Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan
  4. 4Department of Pharmacy, Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan
  1. Correspondence to Cheng-Hsien Hung, Department of Pharmacy, Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan; chenghsien823{at}gmail.com

Abstract

Introduction Chemotherapy-induced peripheral neuropathy (CIPN) affects patients’ quality of life and treatment effectiveness. Gabapentinoids, like gabapentin and pregabalin, are often used for CIPN treatment, but their efficacy and safety remain uncertain. This study reviews and analyses randomised controlled trial data on this topic.

Materials/methods We searched PubMed, Embase and Cochrane CENTRAL until 29 August 2022 for studies on gabapentinoid use in CIPN. Meta-analysis was performed using RevMan V.5.4 and the Metafor package in R. Outcomes included pain scores, quality of life and adverse drug events.

Results For the prevention setting, our meta-analysis shows that pregabalin did not significantly improve average pain (standardised mean difference (SMD) −0.14, 95% CI −0.51 to 0.23; I2=26% (95% CI 0% to >98%)) or quality of life (mean difference (MD) 2.5, 95% CI −4.67 to 9.67; p=0.49) in preventing CIPN compared with placebo. However, it showed a potential trend towards reducing the worst pain (SMD −0.28, 95% CI −0.57 to 0.01; I2=0% (95% CI 0% to 98%; p=0.06)). For the treatment setting, some studies have shown a potential therapeutic effect of gabapentinoids. However, the results are not consistent between studies. Given the studies’ heterogeneity, a meta-analysis in treatment setting was not performed.

Conclusion There is limited evidence to support the use of gabapentinoids in CIPN. In prevention setting, gabapentinoids do not significantly prevent CIPN. In treatment setting, studies have been inconsistent in their conclusions, lacking definitive benefits over placebo. More comprehensive and higher quality research is needed in the future.

PROSPERO registration number CRD42022361193.

  • Cancer
  • Hospital care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors C-HH served as the lead for the integrated analysis. Y-FU and TWC were responsible for literature review and manuscript writing. Y-CL also provided consultation on the disease and polished the manuscript. C-HH, as the guarantor, accepted full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.