目的:化疗引起的周围神经病变(CIPN)的治疗对临床医生具有挑战性,许多关于CIPN的临床试验和荟萃分析存在争议。用于治疗CIPN的药物之间的疗效比较也很少。因此,本系统综述旨在利用现有随机对照试验研究药物治疗CIPN的疗效。方法:在电子数据库中搜索涉及任何药物干预和/或联合治疗CIPN的随机对照试验(RCT)。结果:十七个RCT调查了16个药物类别,度洛西汀,普瑞巴林,crocin,河豚毒素,文拉法辛,单唾液酸四己糖神经节苷脂(GM1),拉莫三嗪,KA(氯胺酮和阿米替林)乳膏,nortriptyline,阿米替林,外用Citrulluscolocynthis(苦苹果)油,BAK(巴氯芬,盐酸阿米替林,和氯胺酮)pluronic卵磷脂有机凝胶,加巴喷丁,和乙酰左旋肉碱(ALC),在CI的治疗中,PN被取回。许多纳入的RCT包括小样本量和短随访期。由于结果指标的高度可变性质,很难量化。结论:度洛西汀,文拉法辛,普瑞巴林,crocin,河豚毒素,单唾液酸四己糖神经节苷脂在治疗CIPN方面表现出一些有益效果。度洛西汀,根据证据审查,GM1和crocin显示出中等程度的益处,而拉莫三嗪,KA奶油,nortriptyline,阿米替林,和外用枸杞(苦苹果)油没有益处。由于加巴喷丁疗效的争议,需要进一步的研究来证实加巴喷丁治疗CIPN的疗效。此外,BAK局部复方镇痛凝胶仅有改善CIPN症状的倾向,但差异无统计学意义。ALC可能导致CIPN恶化。由于样本量小,大多数研究质量不佳。因此,需要采用大样本的标准化随机对照试验来严格评估这些药物在未来治疗CIPN的有效性.
Purpose: Treatment of chemotherapy-induced peripheral neuropathy (CIPN) is challenging for clinicians, and many clinical trials and meta-analyses on CIPN are controversial. There are also few comparisons of the efficacy among drugs used to treat CIPN. Therefore, this systematic review aimed to study the efficacy of drugs in treating CIPN using existing randomized controlled trials. Methods: Electronic databases were searched for randomized controlled trials (RCTs) involving any pharmaceutical intervention and/or combination therapy of treating CIPN. Results: Seventeen RCTs investigating 16 drug categories, duloxetine, pregabalin, crocin, tetrodotoxin, venlafaxine, monosialotetrahexosyl ganglioside (GM1), lamotrigine, KA (ketamine and amitriptyline) cream, nortriptyline, amitriptyline, topical Citrullus colocynthis (bitter apple) oil, BAK (baclofen, amitriptyline hydrochloride, and ketamine) pluronic lecithin organogel, gabapentin, and acetyl l-carnitine (ALC), in the treatment of CIPN were retrieved. Many of the included RCTs consisted of small sample sizes and short follow-up periods. It was difficult to quantify due to the highly variable nature of outcome indicators. Conclusion: Duloxetine, venlafaxine, pregabalin, crocin, tetrodotoxin, and monosialotetrahexosyl ganglioside exhibited some beneficial effects in treating CIPN. Duloxetine, GM1, and crocin showed moderate benefits based on the evidence review, while lamotrigine, KA cream, nortriptyline, amitriptyline, and topical Citrullus colocynthis (bitter apple) oil were not beneficial. Further studies were necessary to confirm the efficacy of gabapentin in the treatment of CIPN because of the controversy of efficacy of gabapentin. Furthermore, BAK topicalcompound analgesic gel only had a tendency to improve the CIPN symptoms, but the difference was not statistically significant. ALC might result in worsening CIPN. Most studies were not of good quality because of small sample sizes. Therefore, standardized randomized controlled trials with large samples were needed to critically assess the effectiveness of these drugs in treating CIPN in the future.