%0 Journal Article
%T Meta-analysis of the usage of drugs affecting the central nervous system for uremic pruritus Metaanaliza bada¨½ dotycz cych stosowania lek¨®w dzia aj cych na o rodkowy uk ad nerwowy w terapii  wi du mocznicowego
%A Anna Bogaczewicz
%A Tomasz Sob¨®w
%A Jaros£¿aw Bogaczewicz
%A Anna Sysa-J£¿drzejowska
%J Clinical Dermatology
%D 2011
%I 
%X 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<0.001), however this investigation did not contain results of pruritus reduction in the control group with placebo, therefore it was not included in meta-analysis. In RCTs assessing the usage of naltrexone and ondansetron no significant differences were found in reduction of the pruritus in comparison to the control group with placebo. Conclusions: Gabapentin and nalfurafine for the tratment of uremic pruritus are more effective than placebo. There is a lack of convincing evidence of advantage of the usage of butophanol, naltrexone, ondansetrone, mirtazapine and doxepin over placebo for uremic pruritus.
%K gabapentyna
%K nalfurafina
%K butorfanol
%K naltrekson
%K ondansetron
%K mirtazapina
%K doksepina
%K wi d
%U http://cornetis.pl/pliki/DK/2011/2/DK_2011_2_69.pdf