Forget Patrice, Vermeersch Mathieu
Institute of Applied Health Sciences, Epidemiology group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, department of Anaesthesia, NHS Grampian, Aberdeen, UK.
Anesthesiology and Perioperative Medicine, Acute and Chronic Pain Therapy, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
Br J Pain. 2021 Nov;15(4):380-387. doi: 10.1177/2049463720945289. Epub 2020 Aug 3.
A confidence evaluation helps to make informed decisions about the results of meta-analyses. The goal of this work is to perform a confidence evaluation of results of a network meta-analysis (NMA) on the digestive side effects of tapentadol in patients with chronic pain.
An updated search in PubMed/Medline and Web of Science search until March 2020 was done to perform pairwise meta-analyses with NMA using random-effect models and confidence in network meta-analysis (CiNeMA) for the confidence analysis.
Twenty-five studies were included in the final analyses. Pairwise and indirect comparisons showed a reduced risk of constipation with tapentadol compared to oxycodone. The confidence evaluation did not raise any concerns in terms of confidence for the oxycodone versus tapentadol comparisons. The oxycodone-naloxone versus tapentadol comparisons showed some concerns, particularly in terms of imprecision and incoherence. Regarding the overall risk of any side effects, the confidence evaluation showed a major concern regarding imprecision, but not for the comparison between tapentadol and oxycodone. However, this comparison showed a major heterogeneity.
A confidence evaluation in meta-analysis on the effect of tapentadol compared to other opioids in chronic pain showed possible imprecision, heterogeneity and/or incoherence. However, with a high level of confidence, tapentadol was associated with a lower incidence of constipation than oxycodone. Confidence analyses can help to get more information from meta-analyses.
可信度评估有助于对荟萃分析结果做出明智决策。本研究的目的是对曲马多在慢性疼痛患者中消化系统副作用的网络荟萃分析（NMA）结果进行可信度评估。
在PubMed/Medline和Web of Science数据库中进行更新检索，直至2020年3月，使用随机效应模型进行成对荟萃分析，并采用网络荟萃分析可信度（CiNeMA）进行可信度分析。
最终分析纳入了25项研究。成对和间接比较显示，与羟考酮相比，曲马多导致便秘的风险降低。在羟考酮与曲马多的比较中，可信度评估未引发对可信度的任何担忧。羟考酮-纳洛酮与曲马多的比较存在一些问题，特别是在不精确性和不一致性方面。关于任何副作用的总体风险方面，可信度评估显示主要担忧不精确性，但曲马多与羟考酮之间的比较不存在此问题。然而，该比较显示出较大的异质性。
对曲马多与其他阿片类药物在慢性疼痛中作用的荟萃分析进行可信度评估，结果显示可能存在不精确性、异质性和/或不一致性。然而，在高可信度下，曲马多导致便秘的发生率低于羟考酮。可信度分析有助于从荟萃分析中获取更多信息。
